This post is authored by Joe Allen, director of Translating Research into Practice at the ACC.

We have come a long way over the past few years with the implementation of Appropriate Use Criteria (AUC) and recognizing the value it provides for patient and physician decision making. The College is often credited by our members, payers, members of Congress and other stakeholders for taking proactive efforts to identify care with minimal benefit and provide tools to guide more appropriate, cost-effective care.

There is a positive outlook for AUC, as accreditation agencies, MOC Part IV, and Physician Quality Reporting System (PQRS) participation in 2013 all offer incentives in many states for use of AUC that can enhance the value of these efforts in a direct way.

Originally, AUC moved the discussion away from self-referral and allowed us to focus on quality with legislators avoiding several efforts to remove the Stark exemption. Congress has approved a specific demonstration project on AUC now being implemented by Centers for Medicare and Medicaid Services (CMS). This bill allowed us to offer an alternative to various payment cuts and avoid movement toward radiology benefits managers (RBMs) for now by CMS.

Several payers have begun discussions with ACC about implementing an alternative to RBMs through a FOCUS decision support tool and Quality Improvement program. Maryland and several other states were able to use AUC as a part of discussions about how standards should be set for review of percutaneous coronary intervention use.  Several states had their own efforts begun to develop their own state based standard and dropped theirs to adopt the ACC AUC.

Some RBMs, although not 100 percent concordant, have changed their policies for approval to more closely align with ACC over time. Some plans also have aligned coverage policies with the AUC, including expanding coverage in some cases for computed tomographic angiography. AUC are being used by the ACC Wisconsin and Florida Chapters to engage payers and the business community in a dialogue about how to stabilize and reform payment using AUC measures and shared decision making.

While there are instances in which AUC have been linked to review, authorization, and other policies that misuse the AUC for individual case review, these policies often preceded the AUC or would have occurred anyhow using more arbitrary criteria. Proactive adoption of AUC tools, review of AUC registry data, engagement in quality improvement efforts like FOCUS, and patient outreach like the Choosing Wisely Campaign can help obviate the need for such third party review in the future. The Criteria are never a perfect match for every patient and thus they should be used to inform and not dictate care for individual patients. AUC are best used to engage patients and practices in discussions of appropriate use, as a mirror to understand patient case mix over time, and to benchmark patient populations against others.

AUC can and will evolve in the future in response to member concerns about cookbook medicine, barriers to care, and misuse of the AUC.  However, the items above are just a few of the many ways AUC have been used to empower physicians and patients and counter the desire for third party regulation of clinical practice.  By doing so, the profession demonstrates the value of various procedures while helping all stakeholders engage in a dialogue on the value of various procedures for different patient populations.

The ACC’s 2012 Legislative Conference is coming up on Sept. 9-11. Also don’t miss the Annual Scientific Session of the American Society of Nuclear Cardiology (ASNC) held Sept. 6-9 in Baltimore, which will cover the latest advances in nuclear cardiology and multimodality imaging. Click here to register.

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