Medicare decision support demo to focus on imaging services

Washington -- The Centers for Medicare & Medicaid Services has chosen five large health systems to help test whether physician clinical decision support systems lead to more appropriate use of advanced imaging services.

The two-year Medicare demonstration will include physician practices recruited by Brigham & Women's Hospital in Boston; Henry Ford Health System in Detroit; Maine Medical Center-Physician Hospital Organization in Portland; National Imaging Associates in Avon, Conn.; and the University of Wisconsin- Madison. CMS will test whether decision support boosts appropriate utilization of certain types of magnetic resonance imaging, computed tomography and nuclear medicine.

When such imaging is ordered for fee-for-service Medicare beneficiaries in the practices, the decision support systems will provide immediate feedback to doctors as to whether the tests are considered appropriate for the patients. Appropriateness assessments will be based on clinical guidelines endorsed by medical specialty societies, CMS said. The demonstration will not affect normal policy governing whether Medicare covers the screenings or what it will pay doctors for them, although physician participants will receive additional payment to provide data to the agency.

CMS Administrator Donald M. Berwick, MD, said the demonstration, required by Congress under 2008 legislation, could help cut down on the effects of inappropriate imaging scans on patients.

"The demonstration provides CMS an opportunity to work closely with individual conveners and physician practices in testing whether the use of decision support systems can improve quality of care by diminishing patient exposure to potentially harmful radiation caused by unnecessary overutilization of advanced imaging services," Dr. Berwick said.

The 11 imaging procedures targeted were chosen because Medicare spends a significant amount covering the scans for seniors, and because medical specialties have developed guidelines for their use. They are:

• Spect MPI
• MRI lumbar spine
• CT lumbar spine
• MRI brain
• CT brain
• CT sinus
• CT thorax
• CT abdomen
• CT pelvis
• MRI knee
• MRI shoulder

Additional information about the imaging demo can be found online (link).