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Re: Trump Administration Hits Brakes On Law To Curb Unneeded Medicare CT Scans, MRIs

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To answer several of you - let's review.

Here is the LAW - Protecting Access to Medicare Act (PAMA) of 2014, Section 218(b), 

 

Section 218 SEC. 218. QUALITY INCENTIVES FOR COMPUTED TOMOGRAPHY DIAG-NOSTIC IMAGING AND PROMOTING EVIDENCE-BASED CARE. - begins on page 25

subpart (b) (b) PROMOTINGEVIDENCE-BASEDCARE.—  begins on page 27

 

‘(A) IN GENERAL.—Not later than November 15, 2015, the Secretary shall through rulemaking, and in consultation with physicians, practitioners, and other stakeholders, specify applicable appropriate use criteria for applicable imaging services only from among appropriate use criteria developed or endorsed by national professional medical spe-cialty societies or other provider-led entities.

 

(B) CONSIDERATIONS.—In specifying applicable appro-priate use criteria under subparagraph (A), the Secretary shall take into account whether the criteria— ‘‘(i) have stakeholder consensus; ‘‘(ii) are scientifically valid and evidence based; and ‘‘(iii) are based on studies that are published and reviewable by stakeholders.

 

EFFECTIVE DATE (page 30)

‘(B) REPORTING BY FURNISHING PROFESSIONAL.—Beginning with January 1, 2017, subject to subparagraph (C), with respect to an applicable imaging service furnished in an applicable setting and paid for under an applicable payment system (as defined in subparagraph (D)), payment for such service may only be made if the claim for the service includes the following: . . . . . 

 

You can read the rest -

That's right - the Trump Administration has delayed the implimentation of this part of the law. 

 

I agree with the law - people should only be getting these imaging services when it is medically necessary and this is determinied by the AUC (Appropriate Use Criteria).

 

The delay is for several reasons - development of this AUC, several PFS propsed rules, posted rules for comments and then the PFS Final Rule.  So as long as the voluntary testing doesn't throw a damper in the requirement - it is good to go in 2021 with penalties to physicians who do not comply starting a year or two later.

 

Trump is not the one that is deciding when you might get one of these test - it is the AUC developed by other physicians using best practice criteria.

 

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Trump Administration Hits Brakes On Law To Curb Unneeded Medicare CT Scans, MRIs

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@JANMB wrote:

 

Now five years after Congress passed this law to reduce unnecessary MRIs, CT scans and other expensive diagnostic imaging tests that could harm patients and waste money, federal officials have yet to implement it.  

"Yet to implement it"  ...FOR GOOD REASON using common sense.    This is GOVT taking charge of your medical care.....you really want TRUMP and congress to tell your doctors what they can or not do for a diagnosis.     What a stupid idea this was to cut costs that will actually  HARM patients.     

 

The whole idea to keep PRE in Pre-existing conditions is to prevent diseases and other maladies from being so toxic it will require more medical assistance and costs.   

.   


JANMB, it's funny that the right foams at the mouth when talking about the government running their health care in reference to a Universal Health Care Plan, yet they support the government meddling in this, making it harder to get certain medical scans that help to diagnose problems early resulting in lower overall medical costs.  They want government intrusion on their own terms and those terms are backwards.

 

AND ............ in reality this whole post is moot because trump has done nothing. This law (new procedures), from the beginning, was scheduled to go into effect in the future that hasn't gotten here yet. Trump is thinking about implementing it sooner, prior to testing the new procedures to see how effective they will be. Just another disingenuous posting from the Right.


"The only thing man learns from history is man learns nothing from history"
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Re: Trump Administration Hits Brakes On Law To Curb Unneeded Medicare CT Scans, MRIs

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Message 3 of 7

Gail - HELLO - Anybody Home Up There? Read it again.

The law was passed in 2014 - Obama was President - he signed it.

 

President Trump is just delaying implementation of it for further study on the affects to doctors and patients.....It was suppose to have been fully implimented by January 2018 but the Trump administration has delayed it until January 2020.....

 

Not according to your link:  CMS - Appropriate Use Criteria Program

 

Program Timeline

Currently, the program is set to be fully implemented on January 1, 2021

 

Prior to this date the program will operate in an Education and Operations Testing Period starting January 1, 2020

 

Beginning July 1, 2018 the program is operating under a voluntary participation period

 

Something like this Gail?

 

Page 1 of 8

APPROPRIATE USE CRITERIA FOR ADVANCED

DIAGNOSTIC IMAGING - December 2018

 

It seems what you've presented shows trump has not put the brakes on. Instead he has shortened implementation by one year.

 

I think Obama's 2014 law is great. I believe health care providers are learning, making the small adjustments they need in order to comply. And since 5% are known scammers, it doesn't seem there would be much difficulty in continuing to keep eye open for finding others.

 

You suggest getting rid of this law that medical providers have been working on processing its multi level steps and, replacing it with what? You warn, “it's coming”. I'm 100% certain this is not news for the people who have been learning the variations necessary for complying with the law.

 

There is no evidence in your links, your words, or anywhere I've found, just this evening, that says trump has done anything at all. Did I miss an executive order or something?

Could this be fake news for professionals who can now praise trump for taking a small burden from them, to include donations and votes. How are we to believe any of this is truthful. I just don't get it because nothing much makes sense. If you have evidence trump has changed this law's time line, please post that. Without that documentation your topic is extremely convoluted.

 

It would be helpful Gail when posting a link that in the first paragraph you don't go off planting a garden of your own with your own words or using another's without also crediting them. Very confusing to know who is who. It's not that difficult to make identifiers within your text. Not to mention plagiarism issues.

 

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Re: Trump Administration Hits Brakes On Law To Curb Unneeded Medicare CT Scans, MRIs

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Something doesn’t sound quite right for this. So I will have side with Jan to say that in no way do I want trump overseeing my medical needs...fact is I wouldn’t want trump to be anywhere near my dog!

If this is designed to designate appropriate use of procedures, does this determine the correct procedures to be implemented? Is this to save money or make the correct diagnosis? Or to be able to penalize doctors that are determined to perform too many procedures, according to trump. 

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Re: Trump Administration Hits Brakes On Law To Curb Unneeded Medicare CT Scans, MRIs

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@JANMB wrote:

 

Now five years after Congress passed this law to reduce unnecessary MRIs, CT scans and other expensive diagnostic imaging tests that could harm patients and waste money, federal officials have yet to implement it.  

"Yet to implement it"  ...FOR GOOD REASON using common sense.    This is GOVT taking charge of your medical care.....you really want TRUMP and congress to tell your doctors what they can or not do for a diagnosis.     What a stupid idea this was to cut costs that will actually  HARM patients.     

 

The whole idea to keep PRE in Pre-existing conditions is to prevent diseases and other maladies from being so toxic it will require more medical assistance and costs.   

.   


HELLO - Anybody Home Up There?  Read it again.

The law was passed in 2014 - Obama was President - he signed it.  

President Trump is just delaying implementation of it for further study on the affects to doctors and patients.

 

The "Appropriate Use Criteria" (AUC) is already used by all types of health providers and insurance companies - widely used by Medicaid providers too cause they know that these test are only called for under certain conditions and not others.  The law just mandates that Medicare follow the same manner of approval as Medicaid and private insurer, including those MA insurers.

 

The only way to actually do away with what seems to be coming (the law) is to pass another law cancelling this one.

 

Doesn't have anything to do with Pre- anything.  It only has to do with when it is medically best practices to schedule these test for a patient.  Providers that schedule them without verification or prior authorization, if that step becomes necessary by a Medicare rule, will not be paid.

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Trump Administration Hits Brakes On Law To Curb Unneeded Medicare CT Scans, MRIs

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Message 6 of 7

 

Now five years after Congress passed this law to reduce unnecessary MRIs, CT scans and other expensive diagnostic imaging tests that could harm patients and waste money, federal officials have yet to implement it.  

"Yet to implement it"  ...FOR GOOD REASON using common sense.    This is GOVT taking charge of your medical care.....you really want TRUMP and congress to tell your doctors what they can or not do for a diagnosis.     What a stupid idea this was to cut costs that will actually  HARM patients.     

 

The whole idea to keep PRE in Pre-existing conditions is to prevent diseases and other maladies from being so toxic it will require more medical assistance and costs.   

.   

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Trump Administration Hits Brakes On Law To Curb Unneeded Medicare CT Scans, MRIs

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Message 7 of 7

FROM CMS:  CMS - Appropriate Use Criteria Program

The Protecting Access to Medicare Act (PAMA) of 2014, Section 218(b), established a new program to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries. Examples of such advanced imaging services include:

  • computed tomography (CT)
  • positron emission tomography (PET)
  • nuclear medicine, and
  • magnetic resonance imaging (MRI)

Under this program, at the time a practitioner orders an advanced diagnostic imaging service for a Medicare beneficiary, he/she, or clinical staff acting under his/her direction,would have to consult a "best practices" guide of "Appropriate Use Criteria" (AUC) for ordering such a medical tool in the assessment of a condition.

 

This law required that doctors consult this clinical guide set by the medical industry before Medicare will pay for many common exams for enrollees.

 

Health care providers who go way beyond clinical guidelines in ordering these scans (the 5% who order the most tests that are inappropriate) will, under the law, be required after that to get prior approval from Medicare for their diagnostic imaging.

 

Kaiser Health News 08/14/2019 - Trump Administration Hits Brakes On Law To Curb Unneeded Medicare CT...

 

Now five years after Congress passed  this law to reduce unnecessary MRIs, CT scans and other expensive diagnostic imaging tests that could harm patients and waste money, federal officials have yet to implement it.  It was suppose to have been fully implimented by January 2018 but the Trump administration has delayed it until January 2020.  But even then, there would be a testing period for a couple of years during which Medicare would still pay for the ordered test if the doc does not comply. 

CMS also said it won’t decide until 2022 or 2023 when physician penalties will actually begin.

 

Critics worry the delays come at a steep cost: Medicare paying for millions of unnecessary exams and patients subject to radiation for no medical benefit.

 

The law applies to doctors treating patients enrolled in the traditional fee-for-service Medicare system. Health insurers, including those that operate the private Medicare Advantage plans, have for many years refused to pay for the exams unless doctors get authorization from them beforehand. That process can take days or weeks, which irks physicians and patients.

 

Not all Medicare imaging tests will be subject to the requirements. Emergency patients are exempt, as well as patients admitted to hospitals. CMS has identified some of the most common conditions for which doctors will have to consult guidelines. Those include heart disease, headache and pain in the lower back, neck or shoulders.

 

A growing number of health systems have used clinical guidelines to better manage imaging services.

 

And, oh yes, other country's controlling their health care cost also rely on such protocols.

 

Read more at the links provided above ~

 

This affects what all seniors in Medicare pay for their Part B premiums - if inappropriate use is held down for these test based on clinical guidelines, it will help to hold down these premium increases.

 

For now - the mandate is on hold pending further input and study - but I think it is going to come - we have to start reigning in health care cost using best practices.

 

Cross posting this on both the Medicare and Insurance Board and the Politics and Current Events Board for wider audience viewing.

What Do You Think?


 

* * * * It's Always Something . . . Roseanne Roseannadanna
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