Healthcare experts associated with various notable institutions urge the Centers for Medicare and Medicaid Services to put together the delayed Imaging Appropriate Use Criteria Program of the agency with quality efforts already running.
Established back in 2014, the initiative involves physicians. Physicians should consult the decision-support system and then order an MR, CT, or any other advanced digital imaging to reduce healthcare waste. However, postponements plagued the system, with CMS recently pushing its penalty phase back one more year, to January 2023.
In a blog published in the Health Affairs, quality experts like John Hopkins, Weill, and Harvard Cornell advocated folding the AUC program into similar endeavors. This request came days after members of Congress instructed the CMS to reexamine its quality mandate, which was created 7 years ago under the Protecting Access to Medicare Act with the intent of curbing the growing expense on imaging.
Andrew Menard, JD, Chief Administrative Officer of Radiology at the Johns Hopkins Health System, and co-authors wrote, “Since PAMA enactment, quality initiatives of CMS has started to move the American healthcare system towards value rather than volume, and patients more than paperwork. As a result, clinical problems and taxpayer saving opportunities, which motivated the Congress to train CMS to come up with a design and then implement PAMA AUC program, which reduced significantly.”
Menard with colleagues also recommended folding some appropriate-imaging uses into the broader Quality Payment Program initiative of the federal agency. They further wrote that the approach would serve patients, clinicians, CMS, and taxpayers the best with the CMS also considering ways to trim the payment models and ease requirements of reporting. Another less effective option, according to Menard and the team, is that CMS and Congress try to simplify the PAMA to improve the clinical, administrative, and operational value of the AUC program.
Physician groups like the American Society of Nuclear Cardiology railed against this initiative of imaging quality and advocated for repeal or even a gap for re-examination. In a recent blog post, society labeled the AUC as an extremely complex, unnecessary, unworkable, and administratively burdensome body. ANCS helped in leading the coalition for over 30 medical societies, pushing lawmakers to give the authorization to review the program before the House Appropriations Committee requests.
Menard and the team advised, “Concerns of the Congress with the recent AUC program are known, and we suggest that the Congress and CMS consider the two legislative approaches.”
Others who signed the blog, Health Affairs, included some of the popular names like Ali Raja, MD, MBA, and practicing emergency physician and engaged with the Department of Radiology, Harvard Medical School; Keith Hentel, MD, practicing emergency & musculoskeletal radiologist, New York-Presbyterian Hospital/Weill Cornell Medical Center; Ramin Khorasani, MD, professor of radiology at the Harvard Medical School, Distinguished Chair for Medical Informatics, Birmingham and Women’s Hospital; and David W. Bates, MD, medical director of clinical and quality analysis, information systems for Partners Healthcare Systems.
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