Policy & Regulations

This channel includes news coverage of healthcare policy and regulations set by Congress, the states, Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services (HHS), U.S. Food and Drug Administration (FDA), and medical associations and societies. 

Use the Best Option First

Eight years ago, I sent an email to Barry Pressman, MD, FACR, radiology chair at Cedars-Sinai Medical Center (West Hollywood, California). My 75–year-old mother, a lifelong nonsmoker whose primary-care physician had diagnosed lung cancer (based on a chest radiograph), needed a referral to a surgeon. Pressman recommended Robert McKenna, MD, who had helped pioneer video-assisted thoracic (VAT) surgery in this country.

Interoperability and Population Health Management: Unlocking the Data

McKesson

As health care moves from fee-for-service to value-based medicine, and, eventually, to population health management, imaging is facing the imperative to redefine its role in the care continuum. “We’ll be focused closely on value and outcome measures in the environment we’re calling imaging 3.0,” says Mike Tilkin, CIO of the American College of Radiology (ACR). “Radiologists will play pivotal roles throughout the care process—from the time a study is ordered to being engaged as a consultant throughout the care cycle to being a resource to the patient.”

Lessons Learned From a Pioneer ACO

On July 16, 2013, CMS announced the results¹ of its accountable-care organization (ACO) program, the Pioneer ACO Model. The program was designed to test the impact of higher levels of shared savings and risk on ACO success, and it attracted 32 participants from around the country. After the first year of participation, seven Pioneer ACOs that did not produce shared savings announced their intention to transition to the lower-risk (and lower-reward) Medicare Shared Savings Program, while two dropped out of the ACO model entirely.

Physicians Are Leery of Exchange Participation

Some observers have commented on the narrow networks associated with many insurance products being offered by the state and federal insurance exchanges mandated by the Patient Protection and Affordable Care Act (PPACA). A new survey¹ of members of the Medical Group Management Association (MGMA) suggests why insurers may be having trouble attracting broader physician panels. The MGMA received more than 1,000 responses from practices representing more than 47,500 physicians.

A Yawning Void

As Ezequiel Silva III, MD, makes perfectly clear in his guest editorial in this issue, the entire continuum of radiology delivery services is inches away from getting slammed—again. The root of radiology’s latest problem is in a 2007 report¹ (based on data of an even earlier vintage) from RTI International, LLC, that recommends separate cost centers for MRI and CT.

The In-office Ancillary-services Exception: Time to Ground the Skyrocket?

Some battles are destined to be fought over and over again. The fight to eliminate the IOASE is one such skirmish; it refuses to go away, after more than a decade of debate.

Washington 2013: Imaging at the Grindhouse

Imaging has been through a long legislative and regulatory grind since the first big blow was struck with the DRA, and there is little to indicate that much will change on that front in 2013, according to Ted Burnes, MPA, director of RADPAC, the political-action committee of the ACR®. With Maurine Dennis, MPH, MBA, a consultant for the RBMA, Burnes copresented “Radiology Economics and RADPAC Update” on May 22, 2013, at the RBMA Radiology Summit in Colorado Springs, Colorado.

The MAC–CMS Disconnect

As we previously reported,¹ last fall, CMS published its supposedly final guidance² on place-of-service requirements for the professional and technical components of diagnostic tests. Transmittal 2563 (later replaced by Transmittals 2613 and 2679) revised the instructions contained in chapter 13 of the CMS manual system for Medicare claims processing. The most recent transmittal became effective on April 1, 2013. On April 25, CMS issued a frequently asked question (FAQ)3 set to respond to additional concerns about the place-of-service instructions. Among other clarifications in the FAQ list, CMS reported that it will be developing a national enrollment policy for telehealth and telemedicine services.

Around the web

The nuclear imaging isotope shortage of molybdenum-99 may be over now that the sidelined reactor is restarting. ASNC's president says PET and new SPECT technologies helped cardiac imaging labs better weather the storm.

CMS has more than doubled the CCTA payment rate from $175 to $357.13. The move, expected to have a significant impact on the utilization of cardiac CT, received immediate praise from imaging specialists.

The all-in-one Omni Legend PET/CT scanner is now being manufactured in a new production facility in Waukesha, Wisconsin.

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