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ACR Advocates Implementation of AUC Program
May 16, 2024
The American College of Radiology® (ACR®) submitted a statement for the record to the U.S. Senate Committee on the Budget in response to a May 8 hearing, Reducing Paperwork, Cutting Costs: Alleviating Administrative Burdens in Health Care. The statement highlights ACR-supported legislation, the Protecting Access to Medicare Act of 2014 (PAMA), and the need for administrative simplification.
In PAMA, Congress recognized the need for utilization management for imaging services. While yet to be implemented, this legislation requires all ordering providers to consult physician developed, appropriate use criteria (AUC) via a clinical decision support mechanism during the ordering of advanced diagnostic imaging services for Medicare beneficiaries.
ACR’s statement explains that the AUC program demonstrated improvement in the ordering of the correct imaging study in hundreds of institutions over several years, and entities using it have shown reductions in unnecessary utilization of imaging studies — resulting in savings to both the institutions and copayment costs to patients. Although Congress required the PAMA program be implemented by 2017, the Centers for Medicare and Medicaid Services (CMS) faced significant logistical difficulty during the regulatory process and indefinitely paused the program in the 2024 Medicare Physician Fee Schedule (MFPS) final rule.
Despite its pause, CMS reiterated its support for the program and estimated that if implemented, the PAMA AUC program could save the Medicare system approximately $700 million annually. ACR highlighted these savings in its statement and proposed adoption of revised, updated legislative text to implement the AUC program. This will not only improve patient care, but offers a utilization management tool superior to and less burdensome than prior authorization.
ACR long supported congressional and regulatory efforts to reduce physician administrative burden across all payment systems and looks forward to working with lawmakers on future policy initiatives.
For additional information, contact Ashley Walton, ACR Government Affairs Director.
In PAMA, Congress recognized the need for utilization management for imaging services. While yet to be implemented, this legislation requires all ordering providers to consult physician developed, appropriate use criteria (AUC) via a clinical decision support mechanism during the ordering of advanced diagnostic imaging services for Medicare beneficiaries.
ACR’s statement explains that the AUC program demonstrated improvement in the ordering of the correct imaging study in hundreds of institutions over several years, and entities using it have shown reductions in unnecessary utilization of imaging studies — resulting in savings to both the institutions and copayment costs to patients. Although Congress required the PAMA program be implemented by 2017, the Centers for Medicare and Medicaid Services (CMS) faced significant logistical difficulty during the regulatory process and indefinitely paused the program in the 2024 Medicare Physician Fee Schedule (MFPS) final rule.
Despite its pause, CMS reiterated its support for the program and estimated that if implemented, the PAMA AUC program could save the Medicare system approximately $700 million annually. ACR highlighted these savings in its statement and proposed adoption of revised, updated legislative text to implement the AUC program. This will not only improve patient care, but offers a utilization management tool superior to and less burdensome than prior authorization.
ACR long supported congressional and regulatory efforts to reduce physician administrative burden across all payment systems and looks forward to working with lawmakers on future policy initiatives.
For additional information, contact Ashley Walton, ACR Government Affairs Director.
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