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SGR fix includes quality standards for imaging

by Loren Bonner , DOTmed News Online Editor
Lawmakers moved closer to a permanent fix this week to end the unpopular sustainable growth rate formula or "doc fix."

The bipartisan policy draft introduced by the Senate Finance and House Ways And Means Committees will include a provision that incentivizes ordering physicians to embrace appropriateness criteria when coordinating medical imaging exams for patients. Basically, the measure would deny payment to these providers who do not follow appropriateness criteria, which is meant to boost quality and cut down on duplicate or unnecessary scanning and their associated costs.

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"It is critical that policymakers establish physician-developed appropriateness criteria as the benchmark to guide the use of advanced medical imaging services. Appropriateness criteria, rather than the blunt instrument of across-the-board imaging cuts, is how to root out inappropriate use of imaging," said Gail Rodriguez, executive director of Medical Imaging and Technology Alliance, in a statement.

The SGR was developed in the 1990s as a way to keep spending on Medicare in line with GDP growth. Medical societies have long lobbied for its repeal. Although they have never gotten it, they have always been granted a reprieve before the cuts have gone into effect.

Lawmakers are hoping to enact a permanent repeal of the SGR formula by Dec. 31 and move Medicare toward performance-based payments. The American Hospital Association called it an "encouraging development."


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