Implementation of clinical decision support tools for imaging
Mead said radiology practices, hospitals and outpatient imaging centers should definitely talk to their risk provider and find out what tools are available through their online portals for CDS to order. There are a few qualified decision support mechanisms that they can easily implement through their portal for their referring physicians to access, she said.
If there is already CDS software built into the system they are using to order imaging exams, that is always the best solution.
“You are already using it in your office. Now you just have to click on another tab. I think it is important that they contact their supplier, contact their hospitals, especially if it is a hospital critical access,” Mead said.
She noted that CMS has different rules for critical access hospitals related to CDS’s mandate, which exempts them. But, she warned, there’s still a lot up in the air about how that billing works if you’re the healthcare provider in that relationship.
The CMS CDS rule is designed to improve quality of care and reduce costs
Mead said the primary goal of the AUC CDS requirement is to improve the quality of care provided to patients by ensuring they get the right test for the clinical question being asked. It can also help reduce overall healthcare costs by reducing the number of expensive imaging tests that are ordered.
“Radiologists and the American College of Radiology (ACR) have the decision support tools in place,” Mead said. “It’s designed to reduce overuse, make sure we’re doing the right exam at the right time. The penalty burden isn’t that heavy on the radiology furniture supplier, but it’s really designed to help educate referring physicians.”
Track who is not using CDS on imaging exam orders
“I’m telling everyone to find out who isn’t providing the code so you can go back to the treating physician or team up with your hospitals and educate them,” Mead explained. “I think there are many ways to go about it without having to refuse care. I think radiologists do a good job of trying to educate providers through protocols, reminding people and telling them it’s not the right exam. They can say, ‘I see you did this, you know, I think we should do this.'”
Expect trial and error and revisions to CMS CDS requirements
Like other Medicare programs implemented in the past, the government will start with what appears to be the best course of action, then review how things are going, gather feedback from providers, and make changes over time.
“I think we’re supposed to approach it as a learning opportunity right now,” Mead said.
Like the hospital measures of 20 years ago, she said things started on a voluntary basis, but would become mandatory with incentive payments for following the rule, or payment penalties if the new rule was not followed. . “I imagine there will be a stick at the end of it all,” Mead said.
Watch the VIDEO: Preparing for Criteria for Appropriate Use of Radiology for Clinical Reporting Decision Support — with Lisa Mead, Strategic Radiology
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VIDEO: Imaging companies call on Congress to repeal appropriate use decision support mandate
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