CMS Selects Sites for Imaging Demonstration Project

Can computerized decision support systems reduce unnecessary advanced imaging tests and radiation exposure? That’s what planners of the Medicare Imaging Demonstration (MID) project hope to find out in their two-year study.

CMS last week announced the selection of five participants in the study, which was authorized by the Medicare Improvements for Patients and Providers Act of 2008.

These sites will recruit physician practices to install the decision support software, which includes medical society guidelines for the procedures. The participants include four hospitals systems (Brigham and Women's Hospital, Henry Ford Health System, Maine Medical Center-Physician Hospital Organization, University of Wisconsin-Madison) and the National Imaging Associates.

During the study, the sites will provide CMS with data from the decision support software programs to see what impact it has on the appropriateness and utilization of advanced medical imaging services in a fee-for-service setting. The study excludes any procedures requiring prior authorization.

During the first six months of the study, the researchers will collect the control data, adding in the software during the last 18 months of the study. Two of the conveners, the Henry Ford Health System and Brigham and Women's Hospital, already use decision support software. CMS hasn’t announced how that will be handled in the study.

The MID project is zeroing in on MRI, CT and nuclear medicine studies, including 11 advanced imaging procedures with high utilization and cost for the Medicare population. The imaging studies include SPECT MPI, MRI of the lumbar spine, brain, knee and shoulder, and CT of the lumbar spine, brain, sinus, thorax, abdomen, and pelvis.

National Imaging Associates noted that as many as one-third of advanced imaging studies are not clinically appropriate, or don’t positively affect the patient’s health outcome or assist the physician in making a diagnosis. This results not only in higher healthcare costs without a patient benefit, but unnecessary radiation exposure to the patients.

The radiology community looks forward to this study continuing the conversation on utilization and cost.

"We are pleased that CMS has taken this step,” said Shawn Farley, spokesman for the American College of Radiology. “Decision support systems, based on ACR appropriateness criteria, help providers prescribe the most appropriate exam for a given indication, can help avoid unnecessary utilization, and do so without taking care decisions out of doctors' hands. We look forward to working with CMS, Congress, and other stakeholders to arrive at sensible medical imaging utilization and reimbursement policies moving forward."

David Fisher, executive director of Medical Imaging and Technology Alliance (MITA) agreed. “We’re pleased that they’re moving forward with the study,” he said, noting the organization worked on crafting the language behind the demonstration project. “We’re hopeful that the focus of CMS on physician-developed appropriateness criteria will lead to a reduction in inappropriate imaging, which should reduce cost.”