SGR Lives Another Year in Controversial Bill, Radiology Groups Pleased

The imaging community is lauding Congress for its inclusion of "Appropriate Use Criteria" (AUC) in its latest one-year delay in cutting Medicare payments to physicians.

By a vote of 64 to 35, the U.S. Senate passed the "Protecting Access to Medicare Act of 2014" (H.R. 4302) on Monday, postponing for 12 months a 24 percent cut through the Sustainable Growth Rate (SGR) formula.

This is the 17^th patch regarding SGR that lawmakers have passed, as Democrats and Republicans continue to disagree on how a permanent SGR repeal would be paid for.Medical imaging societies have come out in praise regarding the bill. The American College of Radiology (ACR) claims that the bill wards off massive provider payment cuts that would have been mandated by the flawed SGR formula; and the bill shows promise for migrating toward modern, evidence-based medicine.

The ACR also supports new mandates under the bill that order providers to consult physician-developed appropriateness criteria when prescribing advanced imaging procedures for Medicare patients; maintain current overall provider reimbursement for the next 12 months; and improve patient safety through stricter controls on radiation dose levels delivered by CT machines.

“As medical imaging is the cutting edge of modern medicine, this requirement is a major step forward in health care reform. Providers will have the latest medical evidence at their fingertips before a scan is ordered - ensuring that patients get the right exam for their condition and avoid unnecessary care. This will reduce unnecessary costs and help pave the way for a more responsive and efficient health care system,” Paul H. Ellenbogen, MD, FACR, chair of the American College of Radiology Board of Chancellors, said in a release.    

The Access to Medical Imaging Coalition (AMIC) also applauded the bill and its support of the diagnostic imaging physician community working with policymakers through the AUC. “We are encouraged by the inclusion of an AUC policy to ensure proper use of medical imaging, rather than calling for restrictive, across-the-board reimbursement cuts for imaging services," Tim Trysla, executive director of AMIC, said in a release. "The best way to support physicians in ordering the right diagnostic imaging scan at the right time is for Medicare to encourage physicians and patients to make treatment decisions that best suit individualized needs and circumstances."

Not all medical societies are pleased with the bill. Physician groups, including the American Medical Association, frowned upon the legislation, specifically upon another one-year delay of addressing full repeal of the SGR. “The AMA is deeply disappointed by the Senate’s decision to enact a 17th patch to fix the flawed SGR formula,” Ardis Dee Hoven, MD, president of the AMA said in a statement. “Congress has spent more taxpayer money on temporary patches than it would cost to solve the problem for good.”

The patch also delays until October 1, 2015, the switch to ICD-10 and mandates that cuts to medical services greater than 20 percent (compared to the previous year) are phased in over a two-year period.

The bill is expected to be signed into law by President Obama today.