Radiologists ready to utilize criteria for imaging orders

Much concerns and minor industry awareness surround a latest program that will need physicians ordering outpatient radiological processes for Medicare beneficiaries to justify ahead of time that the imaging orders are important.

The reimbursement approach targets to have physicians refer to industry-developed appropriateness criteria before ordering advanced—and costly—imaging processes for sufferers, utilizing clinical decision support modules that will be tied into agencies’ electronic health records systems (EHRs).

The program, one of the provisions of the Protecting Access to Medicare Act of 2014 year, will go into effect on the day of Jan. 1, 2018, but several specifics of how the program will work are yet in development, claimed presenters at a session during the annual meeting of the Radiological Society of North America.

The utilization of criteria is hoped to be applied to imaging orders for outpatients for 8 types of studies, termed priority clinical places—coronary artery disease, suspected pulmonary embolism, headache, hip pain, low back pain, shoulder pain, cancer of the lung, and cervical or neck pain, claims Joseph Hutter, MD, a lieutenant commander in the U.S. Public Health Service.

The program will have important impacts on ordering physicians, radiological experts and healthcare agencies, which will require adding imaging-specific modules to their EHR systems and adjusting workflows. Additionally, it could affect the payments for radiology experts in the year of 2018 and force a minor percentage of physicians who regularly override appropriateness criteria to seek pre-authorization for studies starting in the year of 2020.

Criteria to justify contemporary radiological processes for those clinical reasons have been hammered out by RSNA and other professional agencies, presenters claim. Before physicians imaging orders tests, they will require using a clinical decision support module, hoped to be embedded in their EHR systems.

The program has been established through a partnership between the Centers for Medicare and Medicaid Services (CMS) and various professional radiological groups as a way to make sure that imaging services like MRI, CT and nuclear medicine scans meet suitable use criteria. The intent of the attempt is to decrease duplicate or unimportant procedures, states Curtis Langlotz, MD, professor of radiology at the Stanford University Medical Center.

Ordering physicians can select to override the decision on appropriateness given by the module, but outcomes will be compiled over time to assess how regularly physicians comply, or do not comply, with appropriate use criteria, Langlotz claims. By the year of 2020, the top 5% of physicians overriding CDSM decisions will be believed to be outliers and will require having orders for advanced radiological processes subject to pre-authorization.

When the program begins in the year of 2018, it’ll have an instant impact on radiology professionals. Physicians that utilize CDSMs to assess the appropriateness of processes will get a code from the module, which radiologists will require submitting on claims sent for payment to Medicare. Radiologists that do not submit the code to CMS will not be paid, Hutter states.