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An Overlooked Provision of H.R. 4302

April 1, 2014
by Gabriel Perna
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While everyone is talking about Sec. 212 of the Protecting Access to Medicare Act of 2014 (H.R. 4302), which would delay the compliance date of ICD-10 for another year, there is another significant provision in the bill for informatics observers.

Sec. 218 of the temporary Sustainable Growth Rate (SGR) "doc fix" bill, which was passed in the House and Senate and is awaiting Presidential approval, would provide quality incentives for computed tomography diagnostic imaging and promoting evidence-based care. Part of this provision requires the Secretary of the Department of Health and Human Services (HHS) to define clinical decision support mechanisms, determined by various industry stakeholders, that will be used by providers prescribing advanced imaging procedures for Medicare patients.

In a nutshell, says Cindy Moran, a Reston, Va.-based American College of Radiology (ACR) executive vice president of government relations, it mandates ordering physicians to use clinical decision support tools to justify the prescription of those advanced imaging procedures. The provision requires those clinical decision support mechanisms to be used in certified electronic health record (EHR) technology.  Only when the provider informs which clinical decision support mechanism was used to prescribe that study can they receive payment for those services under Medicare.

This evidence-based guideline is a “very important concept,” to Moran and the ACR folks. So much so, they asked for its inclusion in the bill working with various Congressmen and other stakeholders, she says.

They also asked for two other provisions, related to imaging.  One provision forces the Centers for Medicare and Medicaid Services (CMS) to produce data to justify a 25 percent multiple procedure payment reduction on certain imaging procedures provided to the same patient, on the same day, in the same session. The other put a ceiling on the reduction of certain codes.

ACR was one of the few groups to outright support the passage of the SGR “doc fix” bill. It applauded the delay of the ICD-10 mandate as well. Moran said that while the organization didn’t specifically request the delay, she said it will be helpful to the average physician practice, which is overwhelmed by the transition.

Overall, ACR is looking for a permanent fix to the SGR, Moran says. However unlike other advocacy groups, it is pleased with the passage of H.R. 4302.

The ACR wasn’t the only one to applaud those imaging provisions.  The Access to Medical Imaging Coalition (AMIC), which is a nonprofit group that consists of various imaging industry stakeholders, was equally as happy with the bill. In statement, the group said the appropriateness policy is encouraging.

"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,” Tim Trysla, executive director of AMIC, said in a release.