Late Monday, both houses of Congress approved an extension of the Sustainable Growth Rate (SGR) formula, which includes American College of Radiology-backed requirements for imaging.
One of the main provisions in the bill would incentivize ordering physicians to embrace appropriateness criteria when coordinating medical imaging exams for patients. It would deny payment to those providers who do not follow appropriateness criteria, which are meant to boost quality and cut down on duplicate or unnecessary scanning and their associated costs. In addition, the bill gives the secretary of the U.S. Department of Health and Human Services the authority to identify decision-support tools for physicians to consult when ordering imaging tests.
“The imaging provisions in this bill will help remove the conjecture from health policy regarding how much imaging is necessary, whether patients are getting appropriate care and how efficiently America is using its health care resources. For health care reform to truly advance, physicians, as well as patients, have to be comfortable that transparency works both ways. The imaging provisions in this bill are a major step forward for health care,” said Dr. Paul H. Ellenbogen, chair of the American College of Radiology Board of Chancellors.
ACR stated that it has concerns with the expansion of authority of the secretary of HHS to “revalue Medicare physicians payments based on a large number of criteria to be used at the secretary’s discretion.”
Other provisions in the bill include a delay of the new ICD-10 coding system until 2015; a removal of the 24 percent across the board spending cut to provider payments; a mandate that prohibits cuts to medical services greater than 20 percent, phased in over two years, and a requirement for multiple procedure payments where the Centers for Medicare and Medicaid Services would be required to produce data used to justify imaging procedures that occur to the same patient, on the same day, in the same session.
The bill is not a permanent repeal of the controversial SGR formula, which many lawmakers were originally aiming for.
The bill is expected to be signed by President Obama.