Clinical Decision Support and Appropriate Use Criteria: 10 Months Away


By AHRA Regulatory Affairs Committee 

The current effective date for Clinical Decision Support (CDS) and Appropriate Use Criteria (AUC) is January 1, 2018.

AHRA has been, and still is, advocating that CMS push this effective date back at least a year to ensure that imaging professionals have time to properly implement these new mandates. We are hopeful that CMS will decide to delay the CDS/AUC mandate to ensure a smooth roll out of the CDS/AUC policy. CMS must still propose and finalize rules on several aspects of AUC/CDS in this year’s rulemaking cycle which provides them an opportunity to delay the effective date.

AHRA recently conducted a member survey to gauge how feasible the current CDS/AUC implementation timeline is. (See results here.) While the results clearly indicate that a January 1, 2018 implementation date would be quite problematic for most respondents, the good news is that we now have some data to present to the decision-makers at CMS.

The survey revealed that 61% of respondents have not begun to implement CDS/AUC and 9% of respondents don’t even know what CDS/AUC is. [NOTE: If you are unsure about what CDS/AUC is, or if you want a refresher on the CDS/AUC mandate, we would suggest that you review the infographic we created to explain this here.] Furthermore, a staggering 90% of respondents estimated that (excluding budget approval) their organizations would need more than 6 months to implement the CDS/AUC rules. When you include the result that only 26% of respondents felt that they could get a budget approval for this expense in less than 6 months, it is reasonable to state that a majority of respondents would struggle to comply with the January 1, 2018 deadline and that it would still be a challenge for many organizations to be ready by 2019.

Compounding all these timing problems is the fact that several key elements of the CDS/AUC program have not been finalized by CMS yet. Even those who have begun to implement aspects of the CDS/AUC policy now will still have to make the necessary operational changes after those key elements are finalized.

While the survey certainly confirmed some of our fears about the current timeline, it also revealed that there is significant variability and uncertainty regarding the cost of CDS/AUC compliance. 12% of respondents estimated the cost of compliance to be less than $25,000, while 30% of respondents estimated the costs to be over $100,000.

Unfortunately, there is still a significant amount of uncertainty surrounding CDS/AUC. While we are hopeful that CMS will agree with us that 2018 is too soon to implement this properly, there is certainly no guarantee that they will decide to delay this policy. Here are some key dates to keep in mind:

July 2017 (Physician Fee Schedule Proposed Rule)

We anticipate CMS to propose details on how AUC data elements will be appended to Medicare claims. We also expect that CMS will finalize the list of “Qualified Clinical Decision Support Mechanisms.” CMS may stick with their proposed 2018 start date or may choose to propose a later implementation date.

November 2017 (Physician Fee Schedule Final Rule)

AUC data elements on claims will be finalized. This would likely be the last viable opportunity CMS has to delay the 2018 start.

AHRA will continue to monitor the situation and update members as necessary. Please contact us at regulatory@ahra.org.

Comments
One Response to “Clinical Decision Support and Appropriate Use Criteria: 10 Months Away”
  1. Crockett Bone says:

    While it may be entirely unlikely that the implementation date will change, denials may prove difficult given the lack of details provided for reporting compliance and further development that will be needed those details are shared through the CY2018 rule making session.

    Like

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