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The Centers for Medicare & Medicaid Services (CMS) has announced that it is soliciting proposals for participation in a Medicare Imaging Demonstration (MID) authorized by section 135(b) of the Medicare Improvements for Patients and Providers Act of 2008. The MID will test whether the use of decision support systems (DSSs) can improve quality of care, and reduce unnecessary radiation exposure and utilization through promoting appropriate ordering of advanced imaging services.

The two-year demonstration will assess if DSSs have had significant impact on the appropriateness and utilization of advanced medical imaging services ordered for the Medicare fee-for-service (FFS) population. The demonstration will focus on 11 targeted advanced diagnostic imaging procedures within the three designated modalities: magnetic resonance imaging, computed tomography, and nuclear medicine.



According to CMS, in the demonstration physician practices will receive feedback on the degree of appropriateness relative to the specified medical specialty society guidelines. The physician practices will be provided with periodic feedback reports that compare their ordering patterns with those of their peers. The demonstration will then assess the effect of feedback reports on physicians' ordering behavior.

The evaluation will cover a range of advanced diagnostic imaging studies, geographic areas, demographic characteristics, and practice settings (i.e., private and academic practices) in the Medicare FFS program. CMS is seeking participation from 2,500 to 3,500 physicians from 500 to 650 physician practices that vary in size, specialty mix, and type (academic and private practice) for the evaluation.

The American College of Radiology (ACR) advocated for this project during the health care reform debate, to demonstrate that cost savings in imaging could be achieved through increasing quality and decreasing utilization instead of broad cuts to imaging services.

The ACR announced it is currently reviewing the CMS solicitation and accompanying guidelines to consider how the college might participate in the MID. Shawn Farley, Director of Public Affairs for ACR, told DOTmed by email, "The ACR encouraged Medicare to take on this project. It is overall a step in the right direction. We support the use of ACR Appropriateness Criteria-based physician order entry systems as a way to address appropriate utilization. This approach can educate referring physicians regarding which exams may be most appropriate for a given condition and they do not take the decisions out of doctors' hand the way that a third party benefits manager can."

More information on the CMS announcement can be found here:
http://www.cms.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1222075.