Imaging societies clash over bill to require that docs consult appropriate-use criteria

Two medical societies are clashing over proposed legislation that would require physicians to consult appropriate-use criteria before ordering advanced imaging exams. 

The American College of Radiology is advocating for passage of the Radiology Outpatient Ordering Transmission (ROOT) Act, introduced last year in both the House and Senate. It seeks to revive the shelved imaging appropriate-use criteria, which the Centers for Medicare & Medicaid Services tabled in 2023 after years of delay.

ACR CEO Dana H. Smetherman, MD, MBA, MPH, recently testified before a key congressional committee about the importance of passing the ROOT Act. This after the college also recently urged radiologists to contact members of Congress about the bill and lobbied lawmakers in Washington for passage during its annual Hill Day.

In her testimony, Smetherman highlighted a previous analysis from consulting firm the Moran Company. It showed that implementation of the appropriate-use criteria program, along with changes spelled out in the ROOT Act, would save the federal government $2 billion over a 10-year budget window. This on top of saving Medicare beneficiaries another $1.5 billion during the same time. Key members of Congress also recently included the ROOT Act in a policy discussion draft, outlining ways to reform Medicare, she added.

“We applaud this inclusion and encourage Congress to act as soon as possible to provide CMS with the statutory changes necessary to modernize and implement the AUC program,” Smetherman said in testimony before the U.S. House Committee on Energy and Commerce Subcommittee on Health May 20. “These changes would improve patient care, increase ordering accuracy, reduce duplicative scans, avoid unnecessary radiation exposure, and lower costs for both the Medicare program and patients by reducing unnecessary testing and co-pays and contributing to a more efficient, affordable healthcare system.”

Meanwhile, the American Society of Nuclear Cardiology also highlighted Smetherman’s anticipated remarks ahead of the hearing on May 19. ASNC noted that the bill would require most clinicians who order advanced diagnostic imaging to consult appropriate-use criteria using a clinical decision support tool approved by CMS. The agency also would use information to help identify ordering clinicians who have low AUC consultation compliance rates, the nuclear society noted.

“The ACR’s plan is being portrayed as simple and straightforward, but the truth is that not all CMS-approved clinical decision support tools will include AUC developed by the cardiovascular medical societies—the gold standard for determining the most appropriate cardiac imaging test,” the nuclear society said in a news update to its members.

ASNC noted that it has long advocated against mandating that referrers consult appropriate-use criteria.  It contends this could potentially “take away the ability of physicians to use cardiology-developed AUC,” leading to “suboptimal test selection.” The society is asking nuclear cardiologists to contact congress to oppose the bill, contending AUC should be “woven into broader quality improvement efforts and value-based payment models.”

“To be clear, AUC consultation is superior to prior authorization processes, but adding yet another reporting mandate for Medicare fee for service is not going to solve the problems with prior authorization,” ASNC wrote. “Quite the opposite—the ROOT Act’s AUC mandate would add more costs, more time, and more boxes for you and your colleagues to click.”