Physicians push Congress to delay imaging Appropriate Use Criteria Program indefinitely

Dozens of physician groups are pushing Congress to further delay the launch of the imaging Appropriate Use Criteria Program as clinicians continue to grapple with the COVID-19 pandemic.

All told, 27 medical societies signed the request—including the American Society of Nuclear Cardiology—addressed to the heads of three key congressional committees. AUC was first established all the way back in 2014, following passage of the Protecting Access to Medicare Act, but it has been frequently delayed in the years since. Most recently, the feds pushed the go-live date back by another year, to Jan. 1, 2022.

“Congressional action is now urgently needed to delay the AUC Program so physician practices are not forced to make investments in a program the Centers for Medicare and Medicaid Services may never be able to implement as PAMA dictates,” ASNC and other wrote to the chairmen and ranking members in Finance, Ways and Means, and Energy and Commerce on Nov. 7. “The last thing physicians need as they struggle through the COVID-19 pandemic is added regulatory and financial uncertainty.”

The AUC’s aim is to curb unnecessary care in Medicare, requiring that providers consult an electronic clinical decision support system before ordering MR, CT, or other costly imaging. Those who over-order radiology services would be labeled as outliers, with the feds eventually subjecting them to prior authorization requirements. With August’s announcement, CMS said it would not levy any imaging appropriate-use criteria penalties in 2020 or 2021.

ASNC and colleagues, however, are lobbying for an open-ended delay, coupled with a retooling of the program.

“While there may be differing ideas about how the consultation of AUC can be encouraged among clinicians, there is widespread agreement the program cannot be implemented as originally envisioned,” the groups wrote. “For that reason, we ask you to take the decisive step to delay the Medicare AUC Program indefinitely and to engage the entire advanced diagnostic imaging stakeholder community to reach a better, more feasible and less burdensome approach to reward Medicare clinicians who provide high-quality, clinically appropriate care,” they concluded.

You can read the entire letter here. Others signing the note included the American Academy of Family Physicians, the Association of Black Cardiologists, MGMA, and the California and Texas medical associations.