At ACR 2021, the Council reviewed Resolution 1, “ACR Practice Parameters and Technical Standards (PP&TS) Refresh,” which proposed an abbreviated process for approval of the PP&TS. The goal is to save time with a more efficient process to create space to discuss substantive issues affecting ACR members. The resolution stated, “After completion of the field review process, ACR-only PP&TS would be reviewed by the BOC and CSC. If there was unanimous support from the BOC and CSC, the parameter or standard would be officially adopted. If one member of the BOC or CSC dissented, the approval process would proceed normally with consideration and voting by the ACR Council.”
The resolution was referred to the CSC, with instruction to report back to the Council at ACR 2022. Interpreting the will of the Council, the Reference Committee responsible for Resolution 1 stated that there was support for improving the PP&TS process, but a different method was needed.
Council Speaker Amy L. Kotsenas, MD, FACR, formed a CSC Workgroup on Resolution 1comprised of councilors and ACR members who have experience with the PP&TS process, along with ACR staff. As the workgroup began, it immediately became clear that ACR-only PP&TS accounted for a small minority of the total. In formulating a new methodology, with meaningful time savings, the workgroup expanded the scope to include all PP&TS.
The workgroup’s review noted historically low participation during the many opportunities to voice opinions about proposed PP&TS language before the annual meeting. The PP&TS process is time-consuming, particularly for the writing and comment reconciliation committees. In addition, major changes to PP&TS language can lead to frustration when first brought up at the annual meeting. Changes incorporated late in the PP&TS process may have unintended consequences that are not immediately apparent.
Lengthy debates also affect the Council. Not infrequently, the Council may get into a “wordsmithing” discussion, with multiple motions and discussion periods. This may lead to “parliamentary fatigue” — the desire to just finish the session, which may lead to poor decision making. Later resolutions may not get as much discussion as earlier resolutions, even though these may be very important resolutions to the ACR membership.
The workgroup focused on phases of the PP&TS approval process that would increase efficiency, while maintaining or increasing individual members’ ability to influence each PP&TS. To achieve maximum gain, the workgroup’s proposal applies to all PP&TS, including those sponsored by multiple societies. In an effort to gain input from the larger ACR membership, the ACR hosted a virtual town hall on Dec. 9, 2021. Members of the workgroup communicated the plan and invited comments from those in attendance. Additionally, an ACR Engage discussion thread is dedicated to the proposal and the PP&TS process. Our ultimate goal is to devise an easily understood, logical, and inclusive method that does not significantly increase the time commitment of the PP&TS process on members or staff. Below are the main points in the proposal:
All PP&TS would be released for public comment simultaneously with one common deadline.
Currently, PP&TS are released for public comment in three to four groups, each with a separate deadline. This change will result in less confusion over the timing of public comment and may lead to greater participation. During the town hall, we heard several attendees request the public comment period be long enough to allow members time to read and comment on all PP&TS relevant to them.
The workgroup proposes a virtual meeting to discuss the PP&TS, three to four weeks in advance of the ACR annual meeting.
This proposed meeting would function similarly to the reference committee open hearings that typically occur at the annual meeting. A PP&TS Reference Committee would hear testimony from ACR members and entertain changes to the wording of individual PP&TS. Following the virtual PP&TS meeting, the Reference Committee would create a final draft version of the PP&TS for distribution to the Council before the ACR annual meeting.
At the annual meeting, approval of the PP&TS final draft versions would be presented to the Council as a consent agenda item. Any persistent concerns may be resolved by extraction of the PP&TS in question by ACR Councilors after a motion, second, discussion, and simple majority vote by the Council.
The unextracted PP&TS would be passed by the Council after a simple majority vote on the consent agenda. The extracted PP&TS may be debated during the annual meeting at the discretion of the Speaker, Vice Speaker, and the Council. Debate should be limited to minor corrections or PP&TS deemed vitally important. Routine, lengthy PP&TS debate should occur earlier in the approval process. The PP&TS that are not passed during the annual meeting would be submitted for approval at the following annual meeting. Until a new version is passed, pre-existing PP&TS would revert to the previous version. There would not be a PP&TS for new parameters and standards if there was no previous version.
The workgroup’s proposal states that the remainder of the PP&TS process would continue to operate as it currently does.
The proposal gives members multiple opportunities to voice their opinion on proposed wording. At the annual meeting, ACR Councilors may move to extract PP&TS from the consent agenda. The discussion of each individual PP&TS is permitted and encouraged, but the venue for discussion would be changed from the annual meeting to the dedicated virtual PP&TS meeting.
During the town hall, several members agreed with the proposal but mentioned a trial period may be useful. The workgroup agrees that by gradually phasing in this process — perhaps initially putting half the PP&TS through the new method and half through the traditional process — we may best demonstrate the efficiency gains.
While the members of this workgroup evaluated potential pitfalls, it is nearly impossible to foresee every issue that may arise. We ask members to keep an open mind as we all work toward improving the PP&TS process. If we find, after an honest trial period, this is not the best solution, we will have learned a lot about what works and what doesn’t. While we hope this proposal exceeds everyone’s expectations, our goal is to find the best possible solution.