From the November 2015 issue of HealthCare Business News magazine
September can be a very interesting month in Washington, and this year proved to be more interesting than usual or expected.
Even before the August recess started, anticipation was building for Pope Francis’ visit and address to Congress, not to mention the brewing fight over federal spending and the Sept. 30 deadline for keeping the government open. Little did we know in August that it would also bring several released reports that would impact imaging services. Then more: The resignation of Speaker John Boehner, paving the way for one last attempt at a “grand budget bargain” that could include instructions for Medicare/entitlement reductions before he departs. And even more: Anticipated progress on a piece of legislation regarding hospitals and their policies and payments that could open the door for site-neutral payments, a policy that the imaging community has long had concerns with. Here are some other matters that health care professionals should know about and look into:
IOM Report of Sept. 22: Improving Diagnosis in Health Care
On Sept. 22, the Institute of Medicine (IOM) released a report entitled, “Improving Diagnosis in Healthcare” as a continuation of their landmark studies: “To Err is Human: Building a Safer Health System” (2000); and “Crossing the Quality Chasm: A New Health System for the 21st Century” (2001). This new report has a series of recommendations for our nation’s health care system to address the issue of diagnostic errors or misdiagnosis, with an emphasis on diagnostic team members and the diagnostic process, as well as patient and clinician communication.
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There is a discussion regarding imaging services in Chapter 2 of the report about the integration of these services into the diagnostic process and the need for communication and training regarding these services, as well as their appropriate use. To read more about this sentinel report, please visit http:// iom.nationalacademies.org/Reports/2015/Improving-Diagnosis-in-Healthcare.aspx
GAO Report: ‘Medicare: Consideration for Expansion of the Appropriate Use Criteria Program’
On Sept. 30, the General Accounting Office (GAO) released a report entitled, “Medicare: Consideration for Expansion of the Appropriate Use Criteria Program,” and while the report was focused on the expansion of Appropriate Use Criteria (AUC) to pathology and radiation oncology services it did reiterate points regarding the use of AUC in imaging. In particular, it brings back the topic of the need to have a mechanism to tie the use of the AUC to the service that is being ordered to make it effective. This is an important component of the Appropriate Use Criteria program for imaging, starting in January 2017. Otherwise, there is no way to ensure that the value to the health care system of AUC will be realized, such as the use of ultrasound first for the diagnosis of shoulder pain versus MRI. To read more about this report, please visit http://www.gao.gov/products/GAO-15-816