ASNC Impact: Change in Policy Gives AMA Green Light to Lobby on AUC Program

The American Medical Association's House of Delegates (AMA HOD) voted last week to modify AMA policy to allow the Association to engage with Congress to further delay and modify the Medicare Appropriate Use Criteria (AUC) Program for advanced diagnostic imaging.
The policy shift follows an advocacy effort led by ASNC and supported by 20+ other organizations to persuade the AMA HOD to vote for a resolution that would change a policy that has prevented the Association from lobbying for legislative modification of the AUC Mandate. Without a policy change, the AMA was limited to working with the Centers for Medicare and Medicaid Services (CMS) to address challenges with the program's implementation. CMS has made it clear it lacks authority to make significant changes to the program without congressional modification of the law.

ASNC's representatives at the AMA HOD meeting were Nishant Shah, MD, FASNC, and Stephen Bloom, MD, FASNC. Appealing to his physician colleagues at the meeting, Dr. Shah explained why the AMA policy should be changed: "The current AUC Mandate is undiscerning and massive in scope,” he said. “I am optimistic that, with passage of this resolution, our AMA will work with affected medical societies to come to consensus on how best to address the unnecessary complexity, administrative burdens and significant cost of the AUC Program.” 

Nishant Shah, MD, FASNC, and Stephen Bloom, MD, FASNC 

The resolution approved by AMA Delegates reflects compromise language reached with the American College of Radiology, which has not wavered in its support of the AUC Mandate. The compromise averted a fight over the resolution on the HOD floor; however, agreement is lacking over how Congress should act. ASNC and many other medical societies maintain the AUC Mandate should be repealed. ASNC recognizes that convincing Congress to repeal the program without another plan or policy to incentivize appropriate use could prove difficult. 

To read the resolution passed by the AMA HOD ("Alternative Resolution 211"), go to page 56 of the AMA HOD preliminary report

Now What? Status of AUC Mandate Advocacy
With AMA policy now changed to allow congressional lobbying on the mandate, ASNC will ask the AMA to convene stakeholders to identify policy alternatives to the AUC Program. Such alternatives could include scrapping the program for more flexible and sensible approaches for encouraging clinician consultation of AUC.

ASNC has emphasized that this issue is time-sensitive. The penalty phase of the AUC Mandate is set to begin January 1, 2023, or the first January 1 following the end of the COVID-19 public health emergency (PHE). It is unclear whether the Administration will extend the PHE into next year, creating uncertainty for physicians and hospitals that must comply with the AUC Mandate. ASNC is urging Capitol Hill lawmakers to legislate delay of the AUC Mandate until at least 2025, which would allow time for Congress to re-evaluate the program.

This year, Congress added language to a federal spending bill directing CMS to work with medical societies on a report detailing “challenges and successes” associated with implementing the AUC Program and how existing quality improvement programs can encourage appropriate use, potentially negating the need for a stand-alone program. Congress has asked CMS to complete the report by mid-September of this year. ASNC and 43 other medical societies sent a letter to CMS requesting opportunities to engage with the agency.  

In July, CMS will release the 2023 Medicare Physician Fee Schedule Proposed Rule, providing ASNC another opportunity to encourage continued delay of the AUC Program. In the meantime, ASNC will continue to lead advocacy efforts on Capitol Hill and with CMS to stop implementation of the AUC Program and to bring its years of AUC experience to the table to shape policy alternatives.

We will keep you informed.