SGR patch, ICD-10 delay pave road for evidence-based medicine

A bill that will delay the implementation of ICD until at least Oct. 1, 2015, and suspend Medicare’s sustainable growth rate (SGR) formula was passed by the Senate on March 31 with a vote of 64 to 35. The temporary solution also contains a provision to spur evidence-based medicine and improve appropriateness of medical imaging.

Known as the “doc fix” bill, the legislation delays the SGR formula that was slated to cut this year’s physician reimbursement rate by almost 24 percent. A deadline of March 31 was instated for Congress to pass legislation that avoids the payment cut and perpetuates delays of Medicare cuts to physicians until April 1, 2015.

Though Senate Majority Leader Harry Reid acknowledged that the temporary fix is not ideal and that further work is needed to find a permanent solution, organizations such as the American College of Radiology (ACR) are applauding medical imaging provisions that are included in the SGR patch.

ACR released a statement regarding the newly passed “Protecting Access to Medicare Act of 2014” in which they state the legislation will make health care reform more efficient, improve medical imaging quality, better utilization accuracy, and make physician payment policy more transparent.

Per the bill, ordering providers must consult physician-developed appropriateness criteria when recommending advanced imaging procedures for Medicare patients, which would in turn catalyze the use of clinical decision support systems. “This may be the first time that Medicare would require providers to use such point of care, evidence-based ordering for exams or procedures,” remarked the ACR in their press release.

The ACR also is in support of provisions in the bill that will maintain current overall provider reimbursement for the next 12 months, require that cuts to medical services greater than 20 percent are ushered in over a two year period, postpone the use of ICD-10 provider payment codes as ACR aims to prepare radiology providers for transition to the new system, and improve patient safety through stricter control and monitoring of radiation dose levels emitted by CT scanners.

“The imaging provisions in this bill will help remove the conjecture from health policy regarding how much imaging is necessary, whether patients are getting appropriate care and how efficiently America is using its health care resources,” said Paul H. Ellenbogen, MD, FACR, chair of the ACR Board of Chancellors, in the release. “For health care reform to truly advance, physicians, as well as patients, have to be comfortable that transparency works both ways. The imaging provisions in this bill are a major step forward for health care.”