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CMS Announces $10 Million Imaging DSS Demo

Cheryl Clark, for HealthLeaders Media, July 27, 2010

The Centers for Medicare & Medicaid Services proposes to fund a $10 million demonstration of software packages with "appropriateness criteria" or "decision support systems" to help physicians decide whether a patient needs a CT, MRI, or other scan.

“There have been a lot of press and a lot of reports about overutilization of imaging services, and the potential for harm, and I’m sure that had something to do with this,” says Joshua Cooper, senior director of government relations for the American College of Radiology.

“This is something the ACR has been advocating for awhile—the right test at the right time—so we’re pleased to see that this (project) one was chosen out of many right out of the gate.”

To reign in all this expensive and dangerous exposure, the Centers for Medicare & Medicaid Services proposes to fund a $10 million demonstration of software packages with “appropriateness criteria” or “decision support systems” (DSS). There are about five on the market today that guide physicians who aren’t sure what tests they should order for a given patient.

“Unfortunately physicians, primarily primary care doctors, don’t know what the test should be,” Cooper says.  “They’ll order a CT because that’s been their habit," when perhaps an ultrasound or simple X-ray would do just fine.

Some doctors start out with an X-ray, and if that doesn’t find anything, go to an ultrasound, and then a CT, then an MR, then with contrast and so forth on the series, Cooper says.  A sound DSS would get the patient the right test a lot faster. Sometimes, the most expensive test is the right test, and when it is, it should be the first test, he says.

The 11 advanced imaging procedures to be reviewed under the grant include MRI of the brain, lumbar spine, knee and shoulder, CT of the brain, thorax, sinus, abdomen, pelvis and lumbar spine, and Spect MPI, tests associated with high expenditures and utilization in the Medicare fee-for-service population, and the availability of relevant medical specialty appropriateness guidelines, according to CMS. 

The two-year project will start in January, and include payments to physicians and practices that report complete data, to be used to determine appropriateness of the test. According to www.auntminnie.com, CMS seeks 2,500 to 3,000 physicians from 500 to 650 practices that vary in size, geography, and specialty mix. The doctors must submit the data electronically.

Estimates vary over what percentage of imaging tests which are unnecessary, but some studies suggest the number is as many as half.

“It depends on your definition of necessary or appropriate,” Cooper says.

But it’s clear that an even bigger and increasingly looming concern deals with the amount of ionizing radiation many of these expensive tests accumulate.

According to several recent reports, per capita dose of radiation from medical imaging has increased by a factor of nearly six since the early 1980s, an increase associated with undetermined cases of cancer that would otherwise not develop, or develop slower.

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