A proposal that could allow higher payments for physicians who refer patients in accordance with appropriateness criteria has been added to a healthcare reform bill now before the Senate Finance Committee.
A proposal that could allow higher payments for physicians who refer patients in accordance with appropriateness criteria has been added to a healthcare reform bill now before the Senate Finance Committee.
The America's Healthy Future Act of 2009 would create the CMS Innovation Center, a new Medicare program charged with evaluating and implementing physician payment methods that keep quality patient care up and costs down. The bill builds upon a four-decade old law that gives the Secretary of Health and Human Services authority to test new reimbursement approaches. The bill would allocate $10 billion over 10 years to fund the center.
Among the methods suggested to the Senate panel, the innovation center would be required to scale down payments to physicians who do not consult appropriateness criteria before ordering advanced diagnostic imaging services for their patients, said Cynthia R. Moran, assistant executive director for government relations and economic policy at the American College of Radiology.
With the Congressional Budget Office counting up costs of the revised Senate bill, senators expressed concern that the new total will surpass the $856 billion originally estimated by finance committee chair Sen. Max Baucus (D-MT). Members of the Access to Medical Imaging Coalition suggested the innovation center, reasoning that it could help the Senate meet its fiscal goals for healthcare reform and avoid further cuts in radiology reimbursement, Moran said. The ACR is a member of AMIC, a coalition of medical societies, patient advocacy groups, and industry interests allied on imaging issues.
"We feel it is important for Congress to understand that most of the diagnostic imaging that's ordered in the country is not attributable to radiology, but to other physicians," Moran told Diagnostic Imaging. "The system needs to be corrected."
The center would study the practice patterns followed by physicians who refer high volumes of patients to advanced medical imaging. If the program finds that a physician deviates from appropriate utilization standards, his or her reimbursement could be affected, Moran said.
Implementing a policy that sets a sliding payment scale tied to appropriateness criteria would be a good way to educate physicians on how and when to order the right test for the right patients, Moran said. It could be based on physician decision-support order entry, another concept backed by the ACR.
"This is an area that really needs to be explored," Moran said.
The Reading Room: Artificial Intelligence: What RSNA 2020 Offered, and What 2021 Could Bring
December 5th 2020Nina Kottler, M.D., chief medical officer of AI at Radiology Partners, discusses, during RSNA 2020, what new developments the annual meeting provided about these technologies, sessions to access, and what to expect in the coming year.
Current Perspectives on Radiology Workforce Issues and Potential Solutions
March 14th 2024Emphasizing the gravity of the ongoing workforce shortage in radiology, these authors recommend a change agenda focusing on expanded numbers of residency positions, reassessment of educational pathways, maintaining a strong presence in hospital settings and practice level initiatives to reduce administrative burden and achieve appropriate reimbursement beyond RVU measurements.
Could Cloud-Based 'Progressive Loading' be a Boon for Radiology Workflows?
March 13th 2024The newly launched Progressive Loading feature, available through RamSoft’s OmegaAI software, reportedly offers radiologist rapid uploading of images that is faster than on-site networks and other cloud-based systems regardless of the network radiologists are using.