ACEP's Efforts Help Shelter Emergency Ultrasound From Recent Medicare Billing Updates

ACEP News 
June 2009

By Barbara Halpern

ACEP News Contributing Writer

For the last 5 years, ACEP has been watching and warning about potential regulations on emergency ultrasound and imaging because of the explosive growth of Medicare billing for advanced imaging technology. The wait was over on July 15, 2008, when Congress overrode the President's veto and passed the Medicare Improvement for Patients and Providers Act 2008 (MIPPA), far-reaching legislation that updates the Social Security Act.

Based largely on prior legislation, the law limits Medicare payments only to HHS-accredited imaging physicians, facilities, and hospitals, effective Jan. 1, 2012. There is also a provision for a 2-year demonstration project that will determine how the HHS/CMS accreditation system will be implemented and maintained.

ACEP's vigilant efforts, however, kept emergency ultrasound exempt from this far-reaching MIPPA legislation. For years, ACEP has been quietly educating medical practitioners and House and Senate members about the unique ways that ultrasound is used in emergency medicine.

ACEP's Emergency Ultrasound Section has alerted the ACEP Board of Directors and emergency physicians about the undercurrent of government interest in the regulation of imaging services, said Dr. Vivek Tayal, chair of the section. Government concerns were based on the growth of free-standing imaging centers, concerns about patient and employee exposure to x-rays, and the explosive use of and Medicare billing for diagnostic imaging services.

Although the issue has been percolating since 2004, the new MIPPA legislation has only just recently passed because of the dramatically different viewpoints among legislators, regulators, service providers, as well as diverse trade and consumer associations.

ACEP's proactive stance on self-regulating emergency ultrasound for the last 15 years contributed to the victory in getting the regulatory exemption. It started with the advent of ultrasound curricula in 1994 and new practice guidelines, which have been updated twice since 2001. An estimated 95% of the emergency physician programs teach how and when to use ultrasound.

Dr. Tayal expressed excitement about advancements in ultrasound utilization.

"No one would have imagined 5 years ago that we would be using ultrasound on such a wide array of patients. Ideally, almost all emergency departments will be able to access ultrasound as a valuable diagnostic and risk mitigation tool," Dr. Tayal said.

The ACEP Board is reviewing options on the development of an accreditation program over the next 5 years, which could eventually include a Web-based exam, regional examiners, and strict compliance with state and federal guidelines. While this continues ACEP's role as an innovator, it is also important in the external context of the increased regulatory climate and spiraling healthcare costs.

According to ACEP Congressional Affairs Director Brad Gruehn, it is imperative that ACEP remains proactive on ultrasound. "Once the infrastructure exists within HHS/CMS to implement the accreditation, it could be relatively easy to expand the program to include all imaging modalities."

Guidelines for Emergency Ultrasound

Model curriculum for teaching emergency ultrasound was published in 1994. In 1999, ACEP's Emergency Ultrasound Section introduced the AMA House of Delegates Resolution 802 that explicitly stated that specialty-specific guidelines could be used to inform credentialing decisions for clinical ultrasound.

In 2001, ACEP produced specialty-specific guidelines for emergency ultrasound that were lauded as groundbreaking. In 2003, ACEP set guidelines for ultrasound fellowships. In 2006, ACEP updated these guidelines and produced imaging criteria for each established application of emergency ultrasound.

ACEP has collaborated with the Council of Residency Directors of Emergency Medicine (CORD), Society for Academic Emergency Medicine (SAEM), the Residency Review Committee for Emergency Medicine (RRC-EM) and the American Board of Emergency Medicine (ABEM) to agree on residency training guidelines that will be part of the upcoming 2009 updates to practice guidelines.

ACEP continues to be proactive both in self-regulation and on advancing the use of emergency ultrasound into new applications that will further enhance patient care and positive outcomes. New guidelines will be issued this year. Under the Board's leadership, the next step in ACEP's evolution is accreditation.

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