Imaging practices are running out of time to integrate appropriate use criteria (AUC) into clinical workflows before the Protecting Access to Medicare Act (PAMA) requires it in 2018. However, the American College of Radiology (ACR)’s Radiology Support, Communication and Alignment (R-SCAN) network both can prepare providers for the coming federal mandate while improving AUC for the specialty as a whole.
The R-SCAN network is a collaborative endeavor that gives practices access to web-based tools and clinical decision support systems in an effort to optimize imaging. After collecting real-world case data, the R-SCAN team will generate a report of appropriate versus inappropriate exams ordered, before holding and holding educational activities with clinicians and staff.
Starting in January 2018, PAMA will require referring providers to consult appropriateness criteria prior to ordering advanced imaging exams for Medicare fee-for-service patients, spanning modalities including CT, MRI, and PET. CMS has suggested that care providers must report three items on claims to receive full reimbursement:
- CDS mechanism consulted.
- Whether the order adheres to AUC, does no adhere to AUC, or is not applicable.
- National provider identification (NPI) number of the ordering physician.
CMS will also designate certain referrers as outliers, using a set of eight procedures making up about 40% of all Medicare imaging. Up to five percent of providers will be branded as outliers and will be required to obtain preauthorization for Medicare patients.
CMS will release the approved list of CDS vendors in June 2017.
“R-SCAN’s use of AUC-based clinical decision support promotes communication between radiologists and their referring providers and helps position radiologists as a resource to health system administrators, as medicine evolves from volume- to value-based care,” said Max Wintermark, MD, R-SCAN clinical adviser.
More than 130 practices nationwide are participants, representing a pool of more than 4,000 radiologists to draw meaningful data from. Practices can also earn Improvement Activity credits, counting towards the Quality Payment Program administered by CMS.
R-SCAN is funded by a CMS Transforming Clinical Practice Initiative grant awarded to the ACR.