What physicians and health organizations should know about mandated imaging appropriate use criteria Academic Article uri icon

Overview

MeSH Major

  • Adenoma
  • Neuroendoscopy
  • Neurosurgical Procedures
  • Pituitary Neoplasms
  • Sphenoid Bone

abstract

  • © 2019 American College of Physicians The Appropriate Use Criteria Program, enacted by the Centers for Medicare & Medicaid Services in response to the Protecting Access to Medicare Act of 2014 (PAMA), aims to reduce inappropriate and unnecessary imaging by mandating use of clinical decision support (CDS) by all providers who order advanced imaging examinations (magnetic resonance imaging; computed tomography; and nuclear medicine studies, including positron emission tomography). Beginning 1 January 2020, documentation of an interaction with a certified CDS system using approved appropriate use criteria will be required on all Medicare claims for advanced imaging in all emergency department patients and outpatients as a prerequisite for payment. The Appropriate Use Criteria Program will initially cover 8 priority clinical areas, including several (such as headache and low back pain) commonly encountered by internal medicine providers. All providers and organizations that order and provide advanced imaging must understand program requirements and their options for compliance strategies. Substantial resources and planning will be needed to comply with PAMA regulations and avoid unintended negative consequences on workflow and payments. However, robust evidence supporting the desired outcome of reducing inappropriate use of advanced imaging is lacking.

publication date

  • June 18, 2019

Research

keywords

  • Academic Article

Identity

Digital Object Identifier (DOI)

  • 10.7326/M19-0287

Additional Document Info

start page

  • 880

end page

  • 885

volume

  • 170

number

  • 12