This database would eventually be used to identify “outlier ordering professionals.” These are doctors who show a “low adherence” to the “appropriate use criteria.” Starting in 2020, these “outlying” doctors would then be required to seek the advance permission of the government through a “prior authorization” process administered by a government website before they can order services for their patients.
All of these provisions are written to pertain to imaging services and radiologists. But language included at the end of this section of the legislation gives the HHS secretary broad discretion to establish an “appropriate use program for other Part B services.”
This includes everything doctors do outside the hospital. The legislation allows Medicare to apply the same regulatory framework to other medical specialties like oncology.
These provisions are part of a much broader, secular shift toward increasing control of the practice of medicine by the federal government. With “applicable appropriate use criteria,” Washington would have the tool to effectively control the practice of medicine for America’s senior citizens.