New Demo Tests Decision Support Systems for Imaging

In light of reports regarding unnecessary radiation exposure and over-utilization of advanced imaging services, the Centers for Medicare & Medicaid Services (CMS) announced July 22 that it is soliciting proposals for paid participation in a new two-year demonstration that will test whether the use of decision support systems (DSSs) can improve care quality by promoting appropriate ordering of advanced imaging services among the Medicare fee-for-service (FFS) population.

The Medicare Imaging Demonstration (MID), authorized by the Medicare Improvements for Patients and Providers Act of 2008, will focus on magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine advanced imaging diagnostic services. More specifically, 11 advanced imaging procedures—Spect MPI, MRI lumbar spine, CT lumbar spine, MRI brain, CT brain, CT sinus, CT thorax, CT abdomen, CT pelvis, MRI Knee, and MRI shoulder—will be included in the demonstration.

A DSS provides immediate feedback based on current medical specialty guidelines to the physician on the appropriateness of the test ordered for the patient.

“Conveners” will be used to reach eligible physicians interested in participating in the demonstration. Examples of conveners include, but are not limited to, physician groups, integrated health care delivery systems, independent practice associations, radiology benefit managers, health plans, information technology vendors, medical specialty societies, and collaborations among the above parties.

Physician practices will receive feedback on the degree of appropriateness relative to the specified medical specialty society guidelines used under the demonstration provided at the time of order entry into the DSS. Participating physicians also will be provided with periodic feedback reports that compare their ordering patterns against those of their peers. The demonstration will assess the effect of feedback reports on physicians’ ordering behavior.

Conveners and physician practices will be paid for reporting complete data necessary to determine the appropriateness of the test. CMS will pay participating practices based on historic ordering volume. Historical volume calculations will be based on Medicare claims data and apply only to those 11 procedures included in the demonstration, ordered for Medicare FFS patients. Participating physician practices will be classified into volume tiers based on the prior year’s ordering history volume of the 11 procedures, and paid fixed annual payments based on the tier to which they are assigned. The payment will be paid semi-annually, and will be subject to the practice submitting complete and accurate data. CMS will determine the payment amount to the practices, so there is no incentive for increasing or decreasing the number of advanced diagnostic images ordered during the demonstration.

The criteria used in the demonstration will be based on those developed or endorsed by medical specialty societies. Prior authorization processes, which can be used to deny coverage for tests, are not part of the demonstration.

All current Medicare coverage and payment policies are unaffected under this demonstration, assures CMS.

CMS is accepting applications for conveners through Sept. 21. Additional information about this demonstration can be found on the CMS website.

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