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The newly developed Appropriate Use Criteria (AUC) for Ventilation/Perfusion (V/Q) highlights the value the procedure has in the clinical setting and presents clinical scenarios in which it is most useful. It is a vital and well-accepted resource that will help guide physicians, across specialties, on the appropriate use of V/Q imaging in an accurate, safe, and cost‐effective manner; benefiting patients suspected of having acute pulmonary embolism (PE).
Click here to watch a video introduction to the AUC document’s salient points from its multidisciplinary authors who address several clinical scenarios for V/Q Imaging in Pulmonary Embolism and its importance to your practice.
AUC are evidence‐based and expert consensus‐driven guidelines developed to assist medical professionals in making the most appropriate diagnostic and therapeutic decisions when they order and perform a medical procedure. By implementing the AUC, medical professionals will fulfill the requirements of the 2014 Protecting Access to Medicare Act (PAMA) mandated by the Centers for Medicare & Medicaid Services (CMS). Starting January 1, 2018, CMS will require doctors to consult AUC prior to ordering advanced diagnostic imaging services in order to receive Medicare reimbursement. Early adopters of AUC will be eligible to report this use as a high‐weighted improvement activity under the Merit‐Based Incentive Payment System (MIPS) based on a rule proposed by CMS. CMS has designated qualified Provider‐Led Entities (qPLEs)—such as the Society of Nuclear Medicine and Molecular Imaging (SNMMI)—to develop AUCs under the Medicare Appropriate Use Criteria program.
The AUC for V/Q was created as a collaborative undertaking initiated by an SNMMI‐assembled workgroup that included experts from the SNMMI, the European Association of Nuclear Medicine (EANM), the American Society of Hematology (ASH), the Society of Thoracic Surgeons (STS), and the American College of Emergency Physicians (ACEP). The wide diversity of the workgroup committee members provided fair balance among a range of interrelated clinical specialties.
Multiple applications of V/Q imaging were evaluated and rated for appropriateness by the committee. Ratings were based on the consensus of evidence‐based literature, as well as expert opinions, and were heavily weighted toward practical clinical scenarios. Based on the AND/UCLA appropriateness method, the workgroup scored each clinical scenario on a scale from 1 to 9 for the use of V/Q:
The AUC has been published on behalf of SNMMI and will be submitted to CMS for approval.1
The use of V/Q scintigraphy should be considered in many common clinical scenarios in the diagnosis of PE. The AUC guidance for V/Q provides standardization of an evidence‐ and expert‐based diagnostic approach. CMS plans to incentivize physicians to use the AUC through merit‐based reimbursement in a proposed rule on the 2018 Quality Payment Program established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
The AUC for V/Q is particularly applicable for patients with:
The ACEP has endorsed the AUC for V/Q, which is significant as emergency physicians are the primary group of physicians that diagnose or rule out PE