By William T. Thorwarth Jr., MD, FACR, American College of Radiology chief executive officer
The American College of Radiology (ACR) recently took an informal poll of members to gauge their practices’ readiness for the impending mandate that referring physicians consult appropriate use criteria (AUC) before ordering advanced medical imaging for Medicare patients.
This mandate is important to radiologists and allied professionals. Starting (tentatively) Jan. 1, 2018, Medicare will not pay a rendering provider (radiologist or otherwise) for these services (MRI, CT, nuclear medicine and PET) unless the referring provider documents that they have consulted AUC.
More than 50 percent of the admittedly small pool of respondents to this poll stated that they either were completely unprepared for — or had chosen to ignore this Medicare mandate.
While eyebrow-raising, this is not terribly surprising. The Centers for Medicare & Medicaid Services (CMS) has yet to announce specific approved clinical decision support (CDS) “mechanisms.” However, the approved “qualified provider-led entities” that can provide AUC by which referring providers can meet this mandate have been approved, including the ACR Appropriateness Criteria®. CMS will announce the approved mechanisms (we expect that ACR Select® will be one of them) and other specifics in June in the CY2018 Medicare Physician Fee Schedule Proposed Rule. The College will, of course, make members aware of those specifics as CMS provides them. The ACR will also factor these specifics into materials it provides members and others to help them adjust accordingly.
However, the ACR has taken, and continues to take, steps to make members and allied professionals aware of up-to-date ACR resources to help them know where things stand to date and what steps they can take now to be as prepared as possible (pending the MPFS proposed rule) for the new Medicare policy. We are also working with medical professional societies to help ensure that their members can take advantage of these resources. It is critical that radiologists and radiology practices become the local resource to help your institution prepare for the implementation of this mandate!
Please visit the ACR Clinical Decision Support Resource Page often. It will be continually updated as we get closer to the Medicare AUC/CDS mandate start date.
Register to attend ACR 2017 – The Crossroads of Radiology® — to get the latest AUC/CDS developments at these sessions:
- New Horizons for the Young and Early Career Physician
- Imaging That Informs Treatment Decision Making That Enables Improvement in Clinical Outcomes
- Partnering With Your Health System to Select and Implement Clinical Decision Support for Imaging
- Transitioning to Value: Building Collaboration Around Evidence-Based Imaging (Radiology Quality Officer Series)
- Making the EMR Work for the Radiologist
Radiologists and their referring providers are also encouraged to join the Radiology Support, Communication and Alignment NetworkTM (R-SCAN). Funded by CMS and administered by the ACR, R-SCAN allows radiologists and their referring physicians to get familiar with (e.g., use) AUC/CDS prior to the mandate. R-SCAN also allows radiologists to obtain continuing medical education (CME) Credit and American Board of Radiology (ABR) maintenance of certification Part 4 Credit.
The College is here to help you prepare for the new Medicare payment policy. Please take advantage of ACR resources to help you be as prepared as possible.
For more information moving forward, refer to the CMS website, ACR website and ongoing coverage in Advocacy in Action eNews.