CHICAGO — A law passed earlier this year will mandate the use of electronic clinical decision support (CDS) to order imaging studies by 2017. To be reimbursed by the Centers for Medicare and Medicaid Services (CMS) for imaging studies, radiologists will have to document that a CDS was used when the study was ordered.
The implications of the Protecting Access to Medicare Act (PAMA) of 2014 for radiologists and a CMS imaging decision-aid demonstration project were discussed at the Radiological Society of North America’s annual meeting at the session “Clinical Decision Support for Imaging: Update on Current State and New Federal Regulations.”
The federal efforts are intended to reduce overutilization that can drive up health care costs and expose patients to unnecessary radiation.
“Imaging has gone up, and we lead the pack in costs in medicine,” said Keith Hentel, MD, MS, chief of the division of emergency/musculoskeletal radiology and executive vice chair of the department of radiology at New York-Presbyterian Hospital-Weill Cornell Medical Center. “Radiologists and our practices have become targets.”
Hentel noted that some private payers have created radiology benefits management (RBM) programs to reduce unnecessary imaging by requiring prior authorization. But Hentel said there is limited data on the effects of this approach. He noted one study found reduced utilization with RBMs and another that suggested that prior authorization simply shifts more costs to radiologists and ordering physicians’ offices.
Another approach to reduce overutilization and improve quality of care recommended by the Institute of Medicine and others has been to make greater use of CDS systems that can extract data from relevant clinical guidelines and medical studies available to physicians in real-time to help guide their choices.
To test whether CDS could improve physicians’ use of imaging studies, CMS funded the Medicare Imaging Demonstration project conducted at 31 practices with 5128 physicians serving more than 79,000 Medicare beneficiaries. Preliminary data were presented recently and will likely help shaped the implementation of PAMA.
Source: Diagnostic Imaging