By Bill Finerfrock, Capitol Associates
The Protecting Access to Medicare Act (PAMA) of 2014 required CMS to establish a “program to promote the use of appropriate use criteria (AUC) for advanced diagnostic imaging services.” Beginning in 2017, Medicare will require those ordering advanced diagnostic imaging exams (CT, MRI, and nuclear medicine including PET) to demonstrate consultation with an approved AUC developed by a Qualified Provider-Led Entity as a condition for reimbursement to imaging providers.
Earlier this year, CMS solicited proposals from “Provider-Led Entities” who wished to have their AUC on the list of Qualified AUCs.
It is believed that AUC based clinical decision support systems can help improve care quality and appropriateness without delaying needed care. Appropriate use criteria is defined as criteria that is evidence-based (to the extent feasible) and assists professionals who order and furnish applicable imaging services to make the most appropriate treatment decisions for a specific clinical condition.
In mid-June, CMS announced the Qualified Provider-Led Entities whose AUC could be used to meet the PAMA requirement.
Qualified Provider-Led Entities as of June 2016
American College of Cardiology Foundation
American College of Radiology
Brigham and Women’s Physicians Organization
CDI Quality Institute
Massachusetts General Hospital, Department of Radiology
National Comprehensive Cancer Network
Society for Nuclear Medicine and Molecular Imaging
University of California Medical Campuses
University of Washington Physicians
Weill Cornell Medicine Physicians Organization
Bill Finerfrock is the president and owner of Capitol Associates, a government relations/consulting firm. Prior to assuming ownership of Capitol Associates, Bill was a senior vice president in the company for more than 20 years. Capitol Associates was selected to work with AHRA on their regulatory affairs issues. Bill specializes in health care financing, health systems reform, health workforce and rural health. He can be reached at firstname.lastname@example.org.