Beyond the Patch Bill Delays SGR ICD 10 Establishes AUC Program | Cardiology Magazine

Heart of Health Policy | The “Protecting Access to Medicare Act of 2014,” which was signed into law by President Barack Obama on April 1, does more than delay the 24 percent Medicare physician payment cut stemming from the Sustainable Growth Rate (SGR) formula for 12 months. The law also delays ICD-10 implementation and includes a requirement for consultation with appropriate use criteria (AUC) and clinical decision support for advanced diagnostic imaging. Here are some crucial details:

  • ICD-10: The law delays ICD-10 from Oct. 1, 2014 to Oct. 1, 2015. The ACC is closely following what the Centers for Medicare and Medicaid Services (CMS) and industry are saying regarding what practices should do now for ICD-10 and will release additional information as soon as it becomes available.
  • AUC: The law also includes development of an AUC program for certain advanced imaging services. This includes magnetic resonance imaging, computed tomography, nuclear medicine, and positron emission tomography. The law directs CMS to specify applicable AUC by Nov. 15, 2015 and to specify qualified decision support mechanisms for use by ordering physicians by April 1, 2016. AUC reporting is required to begin Jan. 1, 2017. Low adherence ordering professionals face prior authorization requirements in 2020. Critical implementation details remain to be worked out by CMS. The ACC will be engaged every step of the way to ensure that the use of AUC in Medicare works to improve patient care and creates the minimum possible burden for physicians.

Keywords: Health Policy, Patient Care, Tomography, X-Ray Computed, Diagnostic Imaging, Centers for Medicare and Medicaid Services, U.S., Magnetic Resonance Imaging, Nuclear Medicine, Positron-Emission Tomography, Cardiology Magazine, ACC Publications

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