The American College of Radiology (ACR) said it applauds a new proposal introduced in the U.S. Congress to require ordering physicians to consult appropriateness criteria for advanced imaging services.
Included in a draft policy to replace the sustainable growth rate (SGR) formula, the provision would deny payment to providers who perform and interpret the imaging study if the ordering physician did not consult appropriateness criteria, according to the ACR. Prior authorization would also be required for outlier providers whose ordering is inconsistent with their peers. The proposal was introduced in the Senate Finance and House of Representatives' Ways and Means Committees.
In addition, the draft policy would require the Secretary of Health and Human Services to specify appropriateness criteria from among those developed or endorsed by national professional medical societies, such as ACR or other entities. The secretary must also identify mechanisms, such as clinical decision-support tools, by which ordering professionals could consult these criteria, ACR said.
ACR is reviewing the additional provisions included in the policy and will provide feedback to Congress, the U.S. Centers for Medicare and Medicaid Services (CMS), and other stakeholders.
