ASNC lobbies Congress to curb prior authorization, oppose AUC mandates and embrace payment reform
A delegation of 14 members from the American Society of Nuclear Cardiology (ASNC) went to Capitol Hill in June to urge lawmakers to reduce prior authorization burdens, oppose renewed appropriate use criteria (AUC) mandates and advance long-term Medicare payment reform. Among them was Suman Tandon, MD, a cardiac imager at St. Francis Hospital and Heart Center in Roslyn, New York, and ASNC representative to the American Medical Association (AMA) House of Delegates.
Tandon said there is a major need for Medicare payment reform because the current payment system is not sustainable. Tandon highlighted the 2.83% cut to physician payments starting in January 2025, which is part of a long string of payment reductions over the past 25 years. The AMA says physician payments have declined 33% when adjusted for inflation.
"They hear us," Tandon said. "Some of the Congressional leaders did mention to us that the new H.R. 1 bill has payments that are going to be adjusted to 75% of the Medicare economic index. But the solution they have is just a fixed for 2026 and it does not address the long-term issues. Physician payment reform needs to happen for the longer haul. We cannot have little fixes and go back every year; it's a stop gap measure. So I hope that the Congressional leaders remember our stories and examples we've shared and why these issues need to be addressed."
Targeting prior authorization and AI-driven denials
Another major focus of the discussions was support for the Seniors’ Timely Access to Care Act, a bipartisan bill that seeks to reform prior authorization requirements in Medicare Advantage. Tandon emphasized how the increasing use of artificial intelligence by insurers is fueling a rise in automatic denials, delaying or blocking necessary care for patients and increasing the amount of administrative burden for providers.
"We just want Congress to understand what a big problem prior authorization is and also the use of AI and predictive technology in pushing and increasing the number of denials," Tandon explained.
Pushback against new AUC proposals
ASNC led efforts over the past decade to eliminate a Centers for Medicare and Medicaid Services (CMS) requirement for the documentation of appropriate use criteria to be included with every request for advanced imaging exams. ASNC successfully lobbied in Washington to have the provision tabled in 2023 after years of implementation delays in the Medicare Physician Fee Schedule. ASNC argued it would cause to many administrative burdens, along with the added costs for health systems and practices to buy certified AUC software to make the documentation.
However, with the rapid rise of prior authorization requirements from insurance companies, the American College of Radiology (ACR) has pushed Congress to again pursue AUC requirements as a way to reduce or eliminate prior authorizations. The ACR was a major supporter of the bipartisan Radiology Outpatient Ordering Transmission (ROOT) Act, introduced in May, that calls for a renewed implementation of AUC. Tandon said this is unnecessary, because physicians should already be following clinical guidelines for choosing these tests.
"It introduces administrative burdens and cost to the practice, and we already use appropriate criteria. When I have a patient and I'm trying to decide on an imaging test, I am thinking about whether that test is appropriate. I'm also trying to make sure I'm doing the right test for the right patient and getting answers for the clinical question being asked," she said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]