House Republicans propose reviving shelved imaging appropriate-use criteria program
Two House Republicans have proposed reviving the shelved imaging appropriate-use criteria program, drawing praise from the American College of Radiology.
Reps. Diana Harshbarger, R-Tenn., and Blake Moore, R-Utah, recently introduced the Radiology Outpatient Ordering Transmission (ROOT) Act after bipartisan members of the U.S. Senate did the same in May.
The program was first established in 2014 through the Protecting Access to Medicare Act, requiring referrers to consult a decision-support system before ordering advanced imaging in a bid to curb waste. However, the program was plagued by postponements and other challenges, and the Centers for Medicare & Medicaid Services opted to table AUC in 2023.
However, House representatives are now attempting to bring the program back by removing a key barrier to implementation, potentially saving taxpayers upward of $700 million annually.
“The bill would help ensure that seniors receive the most appropriate imaging for their condition, reduce unnecessary radiation exposure, and lower Medicare spending on low-value scans,” ACR said in a Friday announcement praising the bill’s introduction.
Full implementation of AUC was originally supposed to have happened by Jan. 1, 2017. The ROOT Act would get the effort back on track by removing requirements for real-time claims reporting, the “primary barrier” to implementation, advocates note. CMS would, instead, conduct retrospective audits based on this data to “ensure compliance and inform provider education.” An additional carveout further “reduces administrative burden,” exempting those participating in clinical trials or in small rural practices.
Back in May, advocates estimated ROOT Act could reduce federal spending by about $2.2 billion between 2025 and 2034. They also highlighted $1.6 billion in savings for Medicare beneficiaries from reduced cost-sharing over the same period. Besides ACR, others voicing support for the proposal earlier this year included the Tennessee Radiological Society and the American Society of Emergency Radiology. Sens. Marsha Blackburn, R-Tenn., and Catherine Cortez Masto, D-Nev., are co-sponsoring the legislation in the Senate.
“Without ROOT Act passage, the benefits of the AUC program—including improved patient safety, more personalized care and substantial Medicare savings—will remain unrealized,” ACR said in its Oct. 10 announcement.
Meanwhile, other physician societies such as the American Society of Nuclear Cardiology have lobbied against a revival of the appropriate-use criteria program. ASNC has argued the program would add unnecessary additional administrative burdens, along with extra costs for hospitals and physician practices to buy certified AUC software to handle documentation.
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.