The Service Line

Sen. Roger Marshall, a Kansas Republican and physician, has put Medicare’s dormant imaging appropriate use mandate back in play, folding the Radiology Outpatient Ordering Transmission (ROOT) Act into a Senate package that also rewrites how doctors get paid. The American College of Radiology (ACR) reported October 15 that the Senate version of the Patients First Act of 2026, S. 5672, was introduced and referred to the Senate Finance Committee. It mirrors House bill H.R. 9693, from Reps. John Joyce, Greg Murphy and Kim Schrier. The ROOT language would reinstate the Appropriate Use Criteria (AUC) program, requiring ordering clinicians to consult AUC-based clinical decision support when ordering advanced imaging such as CT, MRI and PET, a requirement the Centers for Medicare and Medicaid Services (CMS) rescinded from claims processing in 2024. The same package would tie annual Medicare physician payment updates to the Medicare Economic Index, change budget neutrality policy and revise quality reporting. AuntMinnie lists no Senate cosponsors, so this is a marker, not a moving bill: no hearing or markup has been reported. This continues our July coverage of the ROOT Act; the new development is a Senate vehicle. For an imaging group, a revived mandate would put ordering friction back into referral workflows and give radiology a say in which orders reach the scanner. Confidence: High on the introduction, referral and ROOT content per ACR and AuntMinnie; Low on passage this Congress. Sources: Patients First Act with ROOT Act, American College of Radiology, Patients First Act with ROOT Act introduced in Senate, AuntMinnie.

Reimbursement

Radiology’s biggest arbitration defender is fighting a House bill that would end No Surprises Act dispute resolution altogether. ACR issued a statement October 9 opposing the Lower Premiums, Faster Payments Act from Rep. Frank Pallone, a New Jersey Democrat, which would eliminate the independent dispute resolution (IDR) process and substitute payment rates calculated by insurers. ACR chief executive Dana Smetherman, MD, said independent arbiters “routinely reject insurers’ unreasonably low payment offers.” The American Society of Anesthesiologists and the American College of Emergency Physicians joined the opposition, calling the bill premature given pending IDR reforms. The operating calendar matters more than the bill: CMS’s own No Surprises page shows Federal IDR operations final rules released in May 2026 and user guides for submitting IDR notices and responses outside the IDR Gateway taking effect November 13, 2026. CMS’s most recent public data, covering the first half of 2025, showed providers prevailing in 88 percent of disputes with 87 percent of awards above the qualifying payment amount (QPA), the insurer’s median in-network rate, per ACR’s summary. That win rate is the working capital engine for hospital-based radiology, which is why the repeal bill is now a balance sheet issue for groups that depend on it. Confidence: High on ACR’s position and the CMS dates; Medium on the data, which is dated and reported through ACR’s summary. Sources: ACR opposes bill to end No Surprises Act arbitration, AuntMinnie, No Surprises Act rules and fact sheets, Centers for Medicare and Medicaid Services, Providers prevail in vast majority of IDR claims, American College of Radiology.

Enforcement

A Las Vegas hospital stopped performing mammograms after the American College of Radiology pulled its accreditation, and Nevada regulators now say the practice posed a serious risk to human health. The Nevada Division of Public and Behavioral Health’s Radiation Control Program issued a July 21 technical bulletin on Summerlin Hospital Medical Center, reported by AuntMinnie on October 2. The bulletin says an ACR review found 14 of 30 reviewed cases unacceptable, with several deficiencies classed as severe, and the ACR revoked accreditation in December 2025 after a random image check in October 2025 found significant image quality deficiencies. Regulators cited technologist positioning problems as the most critical issue, and said technologists and interpreting physicians failed to flag inadequate images and order repeats. The Food and Drug Administration (FDA) required the hospital to stop mammography as of December 11, 2025 and to notify patients examined between October 24, 2023 and December 11, 2025. Nevada says it is adding image quality oversight requirements. Patient counts and penalties have not been disclosed. The lesson for any breast imaging program is that a failed accreditation image review now leads to federal shutdown and look-back notification within weeks, a cost that dwarfs the reimbursement for the exams. Confidence: High on the bulletin, accreditation and FDA dates; Medium on the case counts, which we read through a search summary of the state PDF. Sources: Technical bulletin, mammography program review, Nevada Division of Public and Behavioral Health, Nevada says Summerlin Hospital mammography posed serious health risk, AuntMinnie.

Who’s Buying

A 60-center Southeast imaging chain just bought its way into theranostics, and the isotope supply deals around it show where the constraint sits. Capitol Imaging Services acquired Impression Imaging, four outpatient sites in South Florida offering PET/CT, MRI, CT and nuclear medicine, AuntMinnie reported October 16. Terms and the financing source were not disclosed. Impression’s medical director, Michael Fagien, MD, becomes Capitol’s chief medical officer of molecular imaging, advising on radioligand therapy and clinical research, and Capitol says the deal expands its molecular imaging and theranostics business. Three days later, radiopharmaceutical developer Nuclidium and NorthStar Medical Technologies announced a long-term partnership under which NorthStar will produce copper-67, the therapeutic isotope paired with Nuclidium’s copper-61 diagnostic, at its Beloit, Wisconsin campus; no capacity or financial terms were given. The pattern: operators are buying PET sites and physician leaders now, while therapy isotope supply is still being contracted. Confidence: Medium, because both items rest on a single trade report each with no company release found. Sources: Capitol Imaging Services acquires Impression Imaging, AuntMinnie, Nuclidium, NorthStar sign Cu-67 supply and manufacturing deal, AuntMinnie.

Clinical Policy

The radiology workforce pipeline now has an immigration fee problem. ACR joined a coalition on October 5 opposing the H-1B visa fee, noting that international medical graduates make up 11 percent of United States diagnostic radiology trainees. For a specialty already short of readers, any cost or delay on foreign trained residents and fellows lands in the same place as the shortage economics: higher coverage prices and more hospital subsidy at contract renewal. We could not open the coalition letter itself, so the detail rests on AuntMinnie’s summary. Confidence: Medium on the figure and ACR’s position; Low on any near term effect on radiology hiring. Sources: ACR joins coalition opposing H-1B visa fee, AuntMinnie.

The Operator Metric

The number to track this week: 188 percent, how much higher the odds of imaging are after an office visit when the ordering clinician also interprets the image. The Harvey L. Neiman Health Policy Institute, in the Journal of the American College of Radiology, analyzed 24.2 million Medicare fee-for-service office visits from 2021 to 2023. About 13.6 percent of visits had imaging within 30 days, and ordering providers interpreted 33.2 percent of it. Visits with only self-interpreting clinicians had 188 percent higher odds of imaging overall, from 54 percent for magnetic resonance imaging (MRI) to 251 percent for ultrasound, while practices sending all imaging to radiologists had 5 to 41 percent lower odds, with CT the exception. The authors estimate office imaging could fall 17 percent without self-interpretation. For a risk-bearing accountable care organization (ACO) or a group pitching referral steering, this is the utilization lever hiding inside the imaging line. Confidence: High on the findings as reported by the Institute; Medium on causation, since this is an observational association. Sources: Study reveals higher imaging use when ordering clinicians interpret their own imaging, Imaging Technology News, Harvey L. Neiman Health Policy Institute.