Clinical Decision Support
According to current Medicare regulations, starting January 1, 2018, providers who order advanced outpatient imaging tests for Medicare patients must first consult an approved clinical decision support (CDS) system or the studies will not be covered. The new rule applies to advanced medical imaging studies including magnetic resonance imaging (MRI) and computed tomography (CT) diagnostic tests ordered at freestanding imaging centers and hospital imaging centers.
Unless final rules change, starting in January 2018, a medical provider ordering these tests must first consult with approved clinical decision support software. The software will then generate a unique identifier required for Medicare to cover the study.
Medicare is expected to release its approved list of clinical decision support platforms by June 30, 2017.
The new rule is intended to ensure that ordered test meet Medicare’s appropriate use criteria. It is part of an increasing emphasis on evidence-based medical practices and improved outcomes.
Centers for Medicare & Medicaid Services (CMS)
Appropriate Use Criteria Program
In general, Appropriate Use Criteria (AUC) are a set of individual criteria that present information in a manner that links a specific clinical condition or presentation, one or more services, and an assessment of the appropriateness of the service(s). Evidence-based AUC for imaging can assist clinicians in selecting the imaging study that is most likely to improve health outcomes for patients based on their individual context. The goal of this statutory AUC program is to promote the evidence-based use of advanced diagnostic imaging to improve quality of care and reduce inappropriate imaging services. Professional medical societies, health systems, and academic institutions have been designing and implementing AUC for decades.
American College of Radiology (ACR)
ACR Select is a comprehensive, national standards based, clinical decision support database comprising over 3,000 clinical scenarios and 15,000 criteria. The platform provides evidence-based decision support for the appropriate utilization of all medical imaging procedures. It is the digitally consumable version of the American College of Radiology Appropriateness Criteria (ACR AC), ready to incorporate into computerized ordering and EHR systems to guide providers when ordering medical imaging scans. More than 300 volunteer physicians, representing over 20 radiology and non-radiology specialty organizations, participate on the ACR AC expert panels to continuously update these nationally transparent guidelines, and provide real-time access to the latest medical imaging decision support. ACR Select can be integrated with a wide variety of solutions for payers and providers for streamlined workflow at the point-of-care.