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Related
to the recommendation suggesting the development of standards
for physicians who interpret imaging studies (3C), MedPAC directs
that CMS should develop standards for physicians who bill for
interpreting imaging studies (the professional component) to
ensure that they are qualified to do so. While acknowledging
the fact that the implementation of these recommendations would
represent a new direction for Medicare, the MedPAC report comments,
"this policy should improve diagnostic accuracy and treatment.
It should also help control the growth of imaging spending by
restricting payment for interpretation to only qualified physicians."
As
part of recommendations 3C and 3D, a statement synonymous with
facility accreditation was made: "The Secretary [of Health
and Human Services] should select private organizations to administer
the standards." The report discussed the differences amongst
the many medical specialties utilizing specific imaging modalities,
stating, "Because physician specialty organizations often
have different criteria for determining when a physician is
qualified to provide a service, CMS should consult with physician
specialty groups and private accreditation organizations when
developing standards for Medicare payment. The Intersocietal
Accreditation Commission (IAC) has demonstrated that it is possible
for different specialties to agree on common standards. The
IAC uses a process in which representatives of several specialty
groups jointly develop facility and physician standards for
three types of imaging services: echocardiography, nuclear medicine,
and vascular ultrasound."
Recommendation
3E, which relates to the Ethics in Patient Referrals Act, was
put forth by MedPAC to suggest that revisions be made to the
Stark II rules. When justifying the recommendation, MedPAC stated,
"The financial incentives for physicians to refer patients
to imaging centers could lead to overuse or inappropriate use
of imaging services. Thus, the Secretary should revise the Stark
rules to prohibit these arrangements."
Accreditation
allows facilities to demonstrate quality to insurance
carriers, including efficiency of operations by following established
policies and procedures; demonstration of a commitment to quality
and continued education; and adherence to nationally standardized
protocols and metrics for quality assurance.
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