H.R. 5737: Radiology Outpatient Ordering Transmission Act

This bill, known as the Radiology Outpatient Ordering Transmission Act (ROOT Act), aims to amend the Social Security Act specifically regarding the data collection and reporting requirements for imaging services under the Medicare program. Here are the key components:

Changes to Data Collection Requirements

The bill modifies the way data is collected concerning appropriate use criteria for certain imaging services. Starting January 1, 2026, the following changes will take effect:

• The mechanism for reporting will change to require that necessary information is provided to the Secretary of Health and Human Services (HHS) instead of giving documentation to the ordering professional.
• Ordering professionals must include their national provider identifier (NPI) on claims for applicable imaging services.

Definition and Compliance of Ordering Professionals

The bill establishes criteria for identifying "low compliant ordering professionals," which are those who fail to meet specific compliance rates when using qualified clinical decision support mechanisms for ordering imaging services. Annual reviews will be conducted by HHS to determine which ordering professionals fall into this category.

To support this, there are provisions for a compliance rate to be calculated based on the orders placed and the use of clinical decision support mechanisms. The compliance rate will exclude certain orders that qualify for exceptions (e.g., services that are determined to be appropriate even without compliance).

Exemptions and Special Cases

The bill outlines specific exemptions for orders related to:

• Mammography
• Lung cancer scans using computed tomography
• Colonography performed using computed tomography
• Other preventive screenings as determined by the Secretary

Additionally, imaging services ordered by clinicians practicing in small or rural practices, or located in health professional shortage areas, are also exempt from strict compliance requirements.

Annual Studies and Reporting

The Secretary will be required to conduct studies every five years to evaluate the compliance rates of ordering professionals. These studies will assess:

• Compliance with the new regulations
• The impact of the changes on the utilization of imaging services
• Potential mechanisms to enhance compliance, including prior authorization and payment adjustments

Endorsement and Regulations

The bill mandates that the Secretary considers recommendations by specialty societies when defining appropriate use criteria and qualified clinical decision support mechanisms for imaging services. This is aimed at ensuring that the requirements align with the current practices and needs of healthcare providers.

Effective Date

The amendments introduced by this bill are set to take effect on January 1, 2026.

Relevant Companies

• GE (General Electric Company) - A major player in the medical imaging equipment market, GE may experience changes in demand for imaging devices as compliance requirements for ordering professionals evolve.
• MDT (Medtronic plc) - As a manufacturer of medical devices that may include imaging components, Medtronic could be affected by shifts in the market for imaging services resulting from this bill.
• SYK (Stryker Corporation) - A company involved in providing medical technologies, including imaging solutions, which may be impacted by changes in clinical guidelines under the act.