ACR pushes for imaging guardrails as senator seeks solutions to healthcare affordability crisis
A key U.S. senator is seeking ways to address the country’s healthcare affordability crisis, with the American College of Radiology offering one possible solution.
Senate Finance Committee Ranking Member Ron Wyden, D-Ore., recently released a request for information from the public, asking for feedback on proposals including lowering premiums, expanding coverage and simplifying enrollment.
ACR was among those responding, sharing ideas in a news update to its members, published Thursday. The college is pushing for potential alternatives to prior authorization and highlighting imaging appropriate-use criteria as a solution.
“Health plans often describe prior authorization as a way to discourage inappropriate care, encourage adherence to evidence-based standards, protect patient safety, and control costs. ACR supports those goals,” the college wrote in comments dated Oct. 2. “For advanced diagnostic imaging, however, they can be pursued more effectively by giving ordering professionals access to physician-developed clinical guidance when the imaging decision is made, rather than waiting for a health plan to review the order after it has been submitted.”
ACR continues to lobby lawmakers for passage of the Radiology Outpatient Ordering Transmission (ROOT) Act, introduced last year in both the House and Senate. The legislation would revive the shelved imaging appropriate-use criteria program, which CMS tabled in 2023 after years of delay. Advocates estimate that the ROOT Act would eliminate $2 billion in Medicare spending over a 10-year budget window by eliminating requests for unnecessary scans. This on top of saving Medicare beneficiaries another $1.5 billion during the same timeframe.
The college noted that Wyden’s 86-page request for information appropriately identifies imaging as one service increasingly subject to prior authorization. These payer guardrails often can lead to care delays and increasing administrative burdens for both patients and physicians. Since diagnostic imaging often determines the next steps in a patient’s treatment, any setbacks can lead to delays in diagnosis, treatment planning and follow-up care.
“For many patients, advanced imaging is the gateway to definitive diagnosis and treatment,” the college wrote to Wyden. “Delays can postpone the diagnosis of cancer and other serious conditions, potentially resulting in worse outcomes and higher downstream healthcare costs.”
Administrative requirements such as prior authorization can have a disproportionate impact on small and rural practices, which have limited staff and resources. ACR noted that the ROOT Act includes key protections for these providers, ensuring implementation would not result in further burden.
Wyden’s original request also touched on other potential reforms, outside of prior authorization. He suggested possibilities such as reversing Republican Medicaid cuts, making healthcare simpler for families and “taking on corporate greed” in medicine.
“Americans are demanding action to address the dismal reality of healthcare: They are paying more but getting less,” Wyden said in July. “Today’s announcement is the latest step among Senate Democrats to leave no stone unturned as we work to reimagine the American healthcare system so it works for every family. I look forward to bold ideas and perspectives from all comers as senators begin to develop legislative proposals that will meet the moment American families are demanding.”
Several other healthcare groups also responded to the request, including the AAMC, National Health Council, the American Independent Medical Practice Association, and the American Dental Association.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.