ACR suggests 5 ways White House can ease regulatory burden on radiologists

The American College of Radiology recently suggested five ways the White House can ease the regulatory burden physicians are facing in 2025. 

ACR’s recommendations came in response to an April 11 Office of Management and Budget request, searching for regulations that “stifle American businesses” and are ripe for replacement or revocation. 

The college submitted its suggestions on May 9, highlighting a handful of ideas. 

“There are many regulations within the field of medicine that add administrative burden to physician practices and impact Americans’ access to care,” CEO Dana Smetherman, MD, MBA, MPH, wrote to the Office of Management and Budget. 

Here is a rundown of ACR’s suggestions: 

1. Treating physician rule: The college wants the Centers for Medicare & Medicaid Services to remove this “burdensome limitation” on members of the specialty. CMS created the rule to define circumstances in which ordering diagnostic services is deemed “reasonable and necessary.” 

“This arbitrary, bureaucratic decision has disrupted and delayed patient care for years and must be eliminated,” Smetherman wrote. 

CMS rules stipulate that diagnostic tests must be ordered by a treating physician who “furnishes a consultation or treats a beneficiary.” However, agency rules specify that rads performing interventional or diagnostic procedures cannot hold this designation.  

“Changing the treating physician rule would allow radiologists to track important findings and help reduce the exploding data burden on primary care physicians and nonphysician providers,” ACR noted. “Removing the requirement that a radiologist bill an E&M service to be qualified as the treating physician would help alleviate these barriers and allow radiologists to fully utilize their deep expertise in diagnostic testing to support patients and physicians in other specialties.” 

2. Direct supervision for contrast administration: During the COVID-19 pandemic, the feds temporarily allowed virtual direct supervision of level 2 diagnostic tests via audio and video communications. This perk has been extended through Dec. 31, but ACR wants it to become permanent, helping “ensure after hours access to radiology services.” 

“Additionally, virtual supervision will enable better access in rural and underserved areas, where imaging access issues are greater, while still ensuring patient safety,” Smetherman wrote. 

3. Merit-based Incentive Payment System (MIPS): While efforts to move medicine toward value-based care may be valiant, MIPS is overly complex, ACR contends. This has necessitated “continual, extensive, ongoing efforts” by clinicians to maintain compliance and avoid reimbursement reductions. 

This “complex web” of regulations has failed to improve patient outcomes or avoid unnecessary spending. 

“Regulatory simplification is essential to reduce this outsized burden on the teams of providers caring for Medicare patients,” ACR said. “Ultimately, the complexity and cost of MIPS now outweigh its benefits, particularly for resource-limited, specialty-driven practices,” the college added later. 

4. Imaging Appropriate Use Criteria: The 2014 Protecting Access to Medicare Act established AUC to curb inappropriate use of radiology services. Providers were slated to start using it in 2017, but it’s been plagued by delays and implementation challenges.

ACR wants Medicare to make changes to the program, leading to its successful rollout. A previous CMS estimate showed the AUC program could save Medicare $700 million annually. 

Potential modifications could include exempting small and rural practices and removing requirements around real-time reporting. 

“The ACR feels CMS has the authority to make these changes,” Smetherman wrote. “Thus, with minimal effort, the PAMA program could finally be implemented. We believe this technology will evolve and improve with use, can be applied to other services besides imaging, and will generate significant savings to the Medicare program.”

5. No Surprises Act Independent Dispute Resolution process: The NSA was signed into law to protect patients from unexpected medical bills stemming from out-of-network care. ACR emphasized it “strongly supports” efforts to remove healthcare consumers from reimbursement disputes. However, it believes the Biden administration did not implement the NSA as Congress intended, resulting in litigation and overuse of the IDR process by providers. 

“The previous administration was delayed in releasing new regulations, which include policies that would greatly improve efficiency and decrease unnecessary utilization of the federal IDR process,” Smetherman wrote. “The ACR requests the administration consider swift release of the IDR Operations final rule (CMS-9897). This action would remedy the delays in improvements that would be easily implementable as stakeholders have already provided public comment. We believe there are vital reforms included in this regulation that will help improve some of the current deficiencies in the federal IDR process.” 

ACR highlighted its response to the request for information in a news update to its members, published on May 15.