CMS selects appropriate use demonstration participants

The Centers for Medicare & Medicaid Services (CMS) has selected five participants in the Medicare Imaging Demonstration, a demonstration project that promotes appropriate utilization of advanced imaging services.

The two-year demonstration, authorized by section 135(b) of the Medicare Improvements for Patients and Providers Act of 2008, will assess the impact that decision support systems used by physician practices have on the appropriateness and utilization of advanced medical imaging services ordered for beneficiaries in original fee-for-service Medicare.

The demonstration focuses on MRI, CT and nuclear medicine.  Eleven advanced imaging procedures--SPECT myocardial perfusion imaging, MRI lumbar spine, CT lumbar spine, MRI brain, CT brain, CT sinus, CT thorax, CT abdomen, CT pelvis, MRI knee and MRI shoulder--are included in the demonstration.

The 11 tests were selected based on high spending and utilization in the beneficiary population covered by original Medicare and the availability of relevant medical specialty appropriateness guidelines, offered CMS.

The appropriateness criteria used in the demonstration will be medical specialty guidelines that are developed or endorsed by medical specialty societies. The decision support systems provide immediate feedback to the physician about the appropriateness of the test ordered for the patient. The law specifically excludes any approaches that would require prior authorization. The demonstration has no impact on Medicare coverage or payment policies. Demonstration participants will be paid for data.

CMS solicited proposals from interested parties (referred to as “conveners”) that recruited physician practices for participation in the demonstration. Those conveners selected are the Brigham & Women's Hospital in Boston; Henry Ford Health System in Detroit; Maine Medical Center-Physician Hospital Organization in Portland; University of Wisconsin-Madison; and National Imaging Associates in Columbia, Md.

“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 over-utilization of advanced imaging services,” said CMS Administrator Donald Berwick, MD.

Additional information about this demonstration can be found here.