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SNMMI applauds Congress linking physician payment to appropriate use criteria

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April 10, 2014 - The Society of Nuclear Medicine and Molecular Imaging (SNMMI) applauds Congress for its action yesterday in passing historic legislation linking physician payment to appropriate use criteria, thus shifting focus to a more evidence-based health care system. The Senate voted to pass H.R. 4302, the Protecting Access to Medicare Act of 2014, which also passed the House of Representatives by voice vote on March 27. These changes were included as part of the most recent temporary patch to the Sustainable Growth Rate system, which pushes the deadline for SGR repeal to April 1, 2015.

H.R. 4302 requires the Secretary of Health and Human Services to launch a program that encourages the use of appropriate use criteria (AUC) for advanced diagnostic imaging services no later than 2017. Additionally, the Secretary, in consultation with stakeholders, must choose which AUC will be included in the program no later than November 15, 2015.

Through the use of AUC, physicians will be able to better identify which nuclear medicine procedures (including positron emission tomography) are most appropriate for specific patients. In turn, this will lead to cost savings through a better allocation of healthcare resources. AUC, which must be created or endorsed by national medical specialty societies or other provider-led entities, must also have stakeholder consensus; be scientifically valid and evidence-based; and be based on publicly available studies that are published and reviewable by stakeholders.

SNMMI does have concerns regarding the broadness of this legislative language. The implementation of this new payment structure is based on the secretary’s discretion. SNMMI will continue to work with Congress and the secretary to ensure that smaller specialty societies have a voice in selecting the AUCs that will be applicable to the program.

SNMMI also thanks Congress for:

  • passing this one-year patch to the Sustainable Growth Rate system, which delays an overall 24% cut to provider payments. A permanent repeal must be approved before April 1, 2015, to again avoid these cuts.
  • delaying the implementation of ICD-10, which will replace existing coding for medical diagnoses and inpatient procedures, until October 2015. This delay gives physicians additional time to prepare for the transition to the new system, where recording the correct data on their claims forms may be more difficult.
  • phasing in cuts to medical services greater than 20 percent over a two-year period; and
  • requiring the Centers for Medicare and Medicaid Services (CMS) to provide data regarding the 25 percent multiple procedure payment reduction (MPPR), which affects certain imaging procedures provided to the same patient, on the same day, in the same session.

 

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