June 30, 2017

ACR Showcases AUC in Meeting with HHS Tom Price

American College of Radiology (ACR) Chief Executive Officer William Thorwarth Jr., MD, FACR, recently spoke directly with Department of Health and Human Services (HHS) Secretary Tom Price, MD.

Thorwarth explained how appropriate use criteria (AUC) can reduce administrative burdens on providers when ordering advanced medical imaging.

Cynthia Moran, ACR executive vice-president of government relations, economics and health policy, joined Thorwarth in the ACR presentation. The June 22 meeting on eliminating unnecessary federal regulations and administrative requirements was attended by select medical groups.

Seema Verma, director of the Centers for Medicare and Medicare Services (CMS), was also on hand to hear recommendations from the societies representing cardiology, clinical oncology, dentistry, dermatology, psychiatry, osteopathic medicine and radiology.

Price’s interest in regulatory reform is in line with President Donald Trump’s Jan. 30 executive order requiring federal departments to eliminate two prior regulations for each new regulation put in place.

A recent analysis from American Action Forum, a center-right public policy institute, found the 180 major regulations issued by HHS in the past decade tripled the amount of time health facilities devote to regulatory compliance.

Thorwarth responded to questions from ACR Advocacy in Action about the meeting.

What was the potential importance of this meeting with Secretary Price?

Secretary Price has opened the doors at HHS. He is looking for input from physicians and other health care providers to guide his leadership. Hopefully, we will see some impact from the way he and Administrator Verma listened and took copious notes during our presentations.

What did you recommend?
We promote the use of point-of-care appropriate use criteria, particularly related to diagnostic imaging as they were mandated for Medicare in the Preserving Access to Medicare Act of 2014. Implementation of those requirements would, in fact, prevent the institution of prior authorization methods, which we know from the private sector are incredibly burdensome. Many physician offices now have full-time employees who specialize in securing prior authorization for diagnostic imaging, laboratory tests and pharmacy. Prior authorization delays and obstructs care. It interferes with physician-patient relationships. We want to make sure prior authorization doesn’t get implemented in Medicare.

Appropriate use criteria are a much better solution. This is not just about cost containment. It is about providing appropriate imaging care. They enhance patient safety and offer an important educational mechanism to ordering physicians that prior authorization does not provide. Appropriate use criteria may recommend an alternative test or perhaps recommend no test at all for the clinical condition under treatment. With prior authorization, the order is just handed to an assistant who then spends hours on the phone to get an approval.

How was the discussion in the meeting about electronic health records (EHR) relevant to radiologists?
Several medical societies emphasized the need for improved interoperability and integration so their imaging, lab and clinical data can move seamlessly with the patient from facility to facility. Radiologists should be able to tap into the wealth of information in the EHR so they can integrate their diagnostic imaging findings with laboratory data, genomics, proteomics or other sources of clinical data that will allow them to contribute more to patient treatment.

Did the meeting give you reasons to be encouraged about future relations between the ACR, HHS and CMS?
Absolutely so. First, I was impressed that they invited us to share our opinions. Dr. Price and Administrator Verma were very attentive and asked appropriate questions. Because of this background as a practicing physician, Secretary Price was especially attuned to the need to get rid of unreasonable regulations and administrative requirements.

I was also impressed by our team. Christopher Sherin, ACR director of congressional affairs, helped prepare our talking points, and Cindy Moran worked with me to streamline our comments to fit the limited time available for our presentation. All in all, it was a positive experience.