LogicNets Response to the CMS 2024 Proposed Rule Regarding AUC

8 September 2023

LogicNets is a qCDSM under the CMS AUC program. We are 100% committed to continuing to make our AUC Solution available to the market regardless of the CMS proposal to indefinitely postpone the enforcement of CDSM use for advanced imaging. Given this commitment and our exceptional investment in the program, we would like our following response to the 2024 Proposed Rule as regards AUC validation to receive CMS’ serious consideration:

1. We are disappointed at the continued indefinite pause to fully implementing the AUC program as CMS originally envisioned it.  We have had strong initial success with customers and partners in implementing AUC validation through our CDSM and feel confident based on positive feedback from the field that the AUC validation guidance is useful, viable, and has NOT created a hardship for ordering providers.

2. While over the years we have seen continuous lobbying from some quarters against AUC on the grounds that it is disruptive to clinical workflow, we were surprised to learn that the actual rationale for the proposed rule change appears to be solely based on CMS’ inability to itself implement the reporting and auditing functions the agency had set as a key component to the overall program.  In the public-private partnership that is needed to make any broad quality program like the AUC mandate successful in the US, it strikes us that the government has acted in bad faith.  For years, CMS has applied significant and appropriate pressure to well-meaning commercial organizations like LogicNets and its partners, leading to those organizations making significant investments to ENSURE AND ACTUALLY DELIVER a quality product, precisely meeting the functional specifications set forth in the original law.  Yet, CMS cannot meet its own commitment in this area!  And, worse, CMS’s position with regard to this shortcoming is not to reset in a practical way, looking for alternative ways to implement the spirit of the law, but rather to simply postpone the project indefinitely. We truly take issue with the all or nothing approach and believe that CMS has a responsibility to make best efforts to comply with the spirit of the law.

3. We believe that a number of practical and highly effective changes in policy could (and should) be included in the proposed rule to immediately set a path for resolution:

• Proposal 1: Transfer responsibility for reporting and auditing on CDSM/Guideline usage to the CDSMs themselves. Having followed the original functional specifications, our CDSM (and we presume the same to be true for all other qCDSMs) keeps complete records of consultations and the users accessing it and already includes a broad reporting function. CMS could consider requiring qCDSM vendors to generate and provide to CMS regular reports indicating the degree to which any provider’s use conforms to policy expectations. These reports could then be used on an ex post facto basis to enforce the program as originally envisioned, leading outlier physicians to have to follow pre-certification steps until their usage of AUC was within established limits.
• Proposal 2: Truly incentivize the program. For instance, we would propose adjusting
  the MIPS credit program so that MIPS ACTUALLY serves as an incentive for AUC. The feedback we receive from our customers and partners is that it is extraordinarily difficult to gauge the benefit of AUC contribution to their MIPS credit scoring. Many provider customers report back that other quality and efficiency programs simply have a greater impact and that including AUC in their submissions could actually reduce their MIPS credits if used as an alternative. Surely, CMS can simplify MIPS credits with regard to AUC so that providers can weigh the cost of implementing AUC against some form of offsetting savings through MIPS.

4. Finally, AUC is more than a policy for reducing unnecessary costs.  It represents a key milestone in the transformation of healthcare in the US to make digitally formatted knowledge easily accessible to healthcare professionals and patients in context at the moment they need it with the ability to generate and analyze critical data about clinical activity.  Based on our experience, without the AUC program, implementation of general CDSMs linked to a range of critical clinical guidance has been, and will likely continue to be, the equivalent of a high-school science project – interesting, but with little real-world impact.  However, the CDS mechanisms that have resulted from the AUC program to date represent a well-conceived and now-proven approach to deliver critical guidance within the workflow – even at a generic, broader level than advanced imaging.  As a long-time vendor and champion of CDS and other knowledge guidance solutions, we at LogicNets see a healthcare industry that has been stymied for over 10 years by its inability to consistently prioritize and effectively implement available automated clinical guidance and protocols.  It has only been the threat of CMS enforcing use of AUC for advanced imaging that has given a majority of healthcare providers the impetus to actually move into this new world.  We believe that suspending all incentives for implementing AUC delays for at least another 5 years the momentum in the industry needed to generally implement this powerful technology that can not only reduce costs, but can significantly improve clinical outcomes and quality of care in a number of different areas and ways.  The importance of the AUC program is therefore significantly greater than the cost savings that the program already demonstrates it can drive within the Medicare/Medicaid community.  It is an important inflection point in the general modernization of healthcare in the US and has the potential to serve as a great achievement that CMS can point to in the government’s broader objective to serve the American public.