AHRA: Imaging CDS has powerful potential, but questions remain

Ordering advanced imaging with clinical decision support (CDS) can save both time and money, but many of the details on how it will work are still unknown, according to a presentation earlier this week at the AHRA 2015 Annual Meeting in Las Vegas.

The presentation was given by Liz Quam, chair of the Radiology Business Management Association (RBMA) Federal Arms Committee, co-founder and former chair of the Imaging eOrdering Coalition, and executive director of the CDI Quality Institute. She looked at how manufacturers, the Centers for Medicare & Medicaid Services (CMS), and radiology benefits managers (RBMs) were all handling the impending arrival of the 2017 Medicare mandate that requires physicians to consult CDS software when making advanced imaging orders.

Among the positives CDS could offer to imaging providers, various studies show that it can create huge savings, Quam said, and it allows physicians to recommend the most appropriate care possible.

Another huge function of CDS is the amount of data it will make available, and how that data will help bring more accurate care to patients.

“We’re all into big data these days,” Quam told RadiologyBusiness.com in a phone interview. “This is going to be a wonderful resource.”

While providers are excited about the potential of CDS, and manufacturers are already hard at work on the technology that will be required, CMS has been slow to provide many details. July’s proposed rule for the 2016 Medicare Physician Fee Schedule (MPFS) defined some terms related to CDS, but nothing more.

Quam said there are three primary things to watch for from CMS:

• Who will provide the AUC?
• Who is going to provide the actual CDS mechanism?
• How will imaging providers be paid?

Members of the e-Ordering Coalition—a group of healthcare providers, technology companies and imaging vendors that promotes CDS—specifically spoke with CMS about that third point, Quam said, because the final process is still unclear. Imaging providers doesn’t even know how CMS wants to collect the information yet.

“When we in the provider community fulfill the mandate of consulting a CDS mechanism with an approved AUC, how are they going to pay us?” Quam said.

Quam said she is hoping for more guidance from CMS in the final rule, but she is sympathetic to a degree about why CMS may be taking its time. The CDS process involves a lot of different groups, and CMS is likely receiving arguments left and right from all of them, especially after the 2017 mandate became a reality.

“That’s why CMS is having a hard time designing it, because there are so many more stakeholders than there were even two years ago,” Quam said. “It was pretty lonely two years ago, and now it’s like, ‘OK, the party’s grown and is spilling out of the house.’”

RBMs are one group that has a lot at stake as more information about CDS gets finalized in the coming months. When the Protecting Access to Medicare Act of 2014—which created the 2017 mandate—was signed into law, it was a huge blow to RBMs and prior authorization in general. Quam speculated that RBMs might transform and aim to be approved as a mechanism for CDS.

Even if that happens, Quam did say she thinks the old method of RBM prior authorizations, which included broken trust, delayed diagnoses and wasted dollars, is a thing of the past. 

“It might take a few years, but it’s perverse. It needs to go away.”