The AUC Boogeyman Is Not Real

Dr Thorwarth_20140414_008

William Thorwarth, MD

This post was contributed by American College of Radiology Chief Executive Officer William T. Thorwarth Jr., MD, FACR.

Health care is changing. From MACRA to ICD-10, the American College of Radiology (ACR) is addressing challenges that these shifts present and helping radiology transition to the new landscape. However, some changes do not present the challenges some suspect. They may actually help us with recurring issues.

For instance, pending regulations to be issued by CMS later this year, effective Jan. 1, 2018, the Protecting Access to Medicare Act (PAMA) will require referring providers to consult appropriate use criteria (AUC) before ordering advanced diagnostic imaging services (ADIS) — CT, MR, Nuclear Medicine and PET — for Medicare patients.

Providers can access imaging AUC at the point of care via electronic clinical decision support (CDS) systems or CDS software embedded in a physician’s electronic health record (EHR). Barring any changes by CMS, we anticipate providers documenting that they consulted AUC by entering a physician identifier that may be termed a “decision support number” (DSN) in the exam order. ACR developed CDS — ACR Select® (digital ACR Appropriateness Criteria®) — that can be integrated into most common EHRs. ACR Select is expected to meet PAMA requirements. CMS will announce approved CDS systems by June 30.

Imaging providers will not be competitively disadvantaged by this federal requirement.

No rendering provider can receive Medicare payment for ADIS if the referring provider does not properly document that AUC were consulted. All imaging providers can refuse such undocumented Medicare referrals. Imaging providers cannot perform AUC administrative duties for referrers (as many have with prior authorization). In other words, ordering physicians cannot shift the requirement to consult the guidelines to radiologists.

There is no facility “exempt” from these requirements to which providers can shift this Medicare imaging.

Due to rapid imaging growth in the late 1990s/early 2000s, CMS and private payers will continue to monitor and manage imaging utilization. The ACR offered the CDS/AUC solution to ensure appropriate imaging in a way that does not delay necessary treatment, interfere in doctor-patient decisions or penalize radiologists via arbitrary cuts.

By promoting CDS/AUC, radiology can position itself as a resource to hospital and health system administrators. This is a vital opportunity as medicine transitions from volume- to value-based care.

Communicate with referring physicians to ensure that they are aware of the forthcoming mandate.

Given the immediacy of this PAMA requirement, please take part in (with your referring providers) the CMS-funded Radiology Support, Communication and Alignment Network (R-SCAN™) — administered by the ACR.

Use R-SCAN to get familiar with CDS/AUC and obtain continuing medical education (CME) Credit and American Board of Radiology (ABR) maintenance of certification Part 4 Credit.

Also, please read the new ACR Clinical Decision Support (CDS)/AUC Frequently Asked Questions document.

Changes to the AUC program can be monitored through the CMS website. Please also monitor the ACR website and read the Advocacy in Action eNews, where additional information will be published.

  • How are you preparing for CDS/AUC?
  • How have you communicated about the federal requirement with referring physicians?

Please share your thoughts in the comments section below and join the discussion on Engage (login required).

Radiologists Are Essential

The following post was contributed by Kevin M. Rice, MD, a radiologist in Los Angeles, Calif.

Rice_Kevin_edWhat happens if you type in the Google search box: “radiologists are …”? Chances are you may see something like the below screenshot. Wouldn’t you prefer to see: “radiologists are essential”?

We are the only physicians specially trained in patient diagnosis and care through medical imaging. We save lives and health care dollars by detecting diseases early and pinpointing effective treatment for cancer, heart disease and many other diseases. As radiologists, we are a crucial part of the delivery of patient-centered heath care, and we need to be proactive in relaying this truth.

If we stay in our reading rooms glued to our monitors, others will write our narrative. And, we may not like the story that they are telling.

So, what can we do to inform others about our vital role as radiologists?Essential_ed

Ask yourself the following.

  • Are you a valued as an essential member of the health care team? Or, do you show up hours or later just to provide a perfunctory entry into the medical record?
  • Are your reports succinct and actionable? Or, are they so full of hedges they are rendered meaningless?
  • Are you engaged in the medical staff affairs of the hospitals or health care plans you service? Or, are you on the sidelines letting the decisions that affect you and your patients be made without any radiology input?
  • Are you interacting with your patients in a consequential way? Or, are you invisible to your patients?

If you need help, the American College of Radiology (ACR) provides numerous resources (covering, for example, Imaging 3.0, the Radiology Support, Communication and Alignment Network (R-SCAN) and patient- and family-centered care) to help us take a leadership role in shaping America’s future health care system.

What are you doing in your practice as a radiologist to be certain you are considered essential?

Please share your thoughts in the comments section below and/or join the discussion on Engage (login required).


Is Saving Lives Through Mammography Screening Controversial?

The following post was contributed by R. Edward Hendrick, PhD, FACR, a member of the ACR Commission on Breast Imaging.

Hendrick_R_EdwardMedia coverage of screening mammography might lead you to question its effectiveness  —  that is, its ability to save women’s lives. Yet year by year, deaths due to breast cancer deaths continue to drop.

The National Cancer Institute’s SEER database recently updated cancer death rates through 2014. My recent analysis of those data shows that the breast cancer death rate has fallen 38 percent from 1990 through 2014. This continuing downward trend started shortly after increased mammography use began in the mid-1980s. The resulting decline amounts to 274,765 breast cancer deaths averted since 1990 — including 22,054 in 2014 alone.

There’s no controversy here: Regular mammography screening and improved therapies are undoubtedly responsible for the decline in breast cancer deaths. Screening mammography can detect cancer early when it’s most treatable and can be treated less invasively. This also helps preserve quality of life.SEER Data BC Deaths Decline Graph

So, please don’t let your patients go away with the impression that screening for breast cancer doesn’t matter or that the short-term anxiety of waiting for test results somehow negates the lifesaving effect of screening mammography.

Screening mammography continues to save lives and preserve the quality of life every day, every week, every year.

Take advantage of the resources that the American College of Radiology and Society of Breast Imaging make available.

How do you relay to your patients the proven effectiveness of regular mammography screening at reducing breast cancer deaths?

 Please share your thoughts in the comments section below and/or join the discussion on Engage (login required).