Lawmakers welcome evidence-based Medicare guidelines

A bipartisan group of lawmakers, who are also medical professionals, are applauding the Centers for Medicare and Medicaid Services’ (CMS) response to a measure aimed at decreasing unnecessary imaging diagnostic tests in the Medicare system.

Under a regulatory framework outlined in the CMS’ 2016 Medicare Physician Fee Schedule, physicians would rely on evidence-based medicine before ordering diagnostic imaging tests, such as MRIs and CT Scans for Medicare patients.

In a letter to Department of Health and Human Services HHS Secretary Sylvia Mathews Burwell, House Energy and Commerce Subcommittee on Commerce, Manufacturing and Trade Chairman Michael C. Burgess (R-TX), who is also a doctor, stated that the lawmakers were “strongly supportive of ensuring that physicians are armed with evidence-based tools to aid in diagnostic decision making.”

Also signed by U.S. Reps. Tom Price (D-GA) and Ami Bera (D-CA), who are also physicians, the letter stated that any guidelines that are not developed by clinicians, providers or national medical professional societies, “do not rely upon the same rigorous development process and, therefore, are more reflective of consensus of medical opinions rather than rooted in clinical evidence.”

Under the Protecting Access to Medicare Act of 2014, referring physicians were told as of January 2017 they must use “appropriate use criteria” when ordering advanced imaging for Medicare patients as part of an effort to reduce duplicate or unnecessary scanning. CMS, in turn, is required to define and implement the “appropriate use criteria” by Nov. 15.