VIDEO: AMA will ask Congress to revise clinical decision support mandate for cardiac imaging

Bloom is director of clinical research at Midwest Heart and Vascular Specialists, Overland, Kansas. Shah is an assistant professor of medicine at Brown University.

The AMA House of Delegates at its 2022 meeting in Chicago approved a resolution asking Congress to change the requirements in a Centers of Medicare and Medicaid Services (CMS) rule requiring all advanced imaging exams (CT, MRI and nuclear) have documentation showing the ordering physicians used clinician decision support (CDS) software to ensure the exam ordered met appropriate use criteria (AUC)

The mandate was included in the Protecting Access to Medicare Act of 2014 (PAMA) and was supposed to be implemented several times since passage, but CMS has delayed it. The new implementation date is January 2023, or when the COVID-19 emergency officials ends. 

The delays have been ongoing because of technical issues, as well as complaints from imaging medical societies concerned about the extra administrative burden the measure will bring, such as adding additional staff time for tracking things down or changing orders. 

The goal of the legislation is to reduce costs associated with unnecessary, expensive imaging exams. However, the policy penalizes radiologists or cardiac imaging specialists reading the exams with non-payment if an order does not have CDS documentation. This is despite the fact that CDS software use needs to come from the referring physicians and cannot be amended by the radiologist or cardiologist in the order. 

In cardiology, this applies to all nuclear imaging scans (PET and SPECT), cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI).

ASNC has spearheaded efforts to get either revise or repeal this mandate. The society have gotten more than 40 medical societies to sign on to a letter to congress asking for revision to the law.

ASNC brought the resolution to the AMA for consideration, and in negotiations with the American College of Cardiology (ACR), the policy was added to remove the term "repeal" and instead push for changes to reduce administrative burden. The resolution was approved by the House of Delegates June 14. The ACR wants imagers to retain control over what exams are deemed appropriate and agrees with the concept of AUC CDS, just not in its current administrative form.

find more information on this policy in the VIDEO: AMA will ask Congress to change mandate on appropriate use criteria clinical decision support — interview with radiologist and AMA Board Trustee member Alexander Ding, MD
 

Related AMA and AUC Coverage:

American Society of Nuclear Cardiology urges Congress to speed prior authorizations, repeal AUC mandate.

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VIDEO: Imaging societies ask Congress to repeal appropriate use decision support mandate — interview with Randall Thompson, MD, former ASNC president.

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