- TEG Clinical Decision Support
- Apri Print
- Radiology Clinical Decision Support
Clinical decision support (CDS), an early entrant to healthcare IT, can reduce mistakes in medication administration, encourage practice standardization, and reduce duplication or unnecessary performance of diagnostic tests.
When neatly integrated into an electronic health record platform, CDS can facilitate evidence-based clinical decisions. Built on a backbone of algorithms, rules and alerts, CDS is a cornerstone of patient safety, healthcare quality, and cost-effective care.
Congress upped the ante for CDS with the Protecting Access to Medicare Act (PAMA). Passed in April 2014, the immediate effect of the law was to forestall implementation of the SGR. Nevertheless, PAMA is not limited to issues of physician reimbursement. It also details a mandate meant to change physician behavior – specifically regarding the utilization of high-end imaging studies in the outpatient setting.
One of the nearly 40 sections of this law, Section 218, outlines an approach effectively aimed at decreasing utilization by encouraging adherence to specialty-vetted clinical practice guidelines for the ordering of these costly tests. These practice guidelines, or appropriate use criteria, are meant to drive the development and implementation of radiology decision support tools. This has become a major challenge to entities that provide radiology services – the mandate to provide CDSS to referring physicians.
Set to take effect Jan. 1, 2017, PAMA is reminiscent of the EHR Incentive Reimbursement Program (Meaningful Use). Since its inception, Meaningful Use has been a puzzle to most who practice radiology. MU’s core objectives comprise the build of a replete centralized patient health record. But, unlike other disciplines in medicine, EHR design does not conform to radiology workflow and process. With the passing of this law, PAMA is something of a declaration that RIS and PACS do not go far enough to improve the health of our patients and to decrease healthcare expenditures.
A close reading of the law reveals three parallel strategies:
- Ordering physicians must confirm that the appropriate use criteria are consulted when ordering CT, MRI, nuclear and PET studies. Important to note is that adherence will not be required. However, it will be measured by CMS.
- Providers of radiology services will be required to offer CDSS to ordering physicians. The law explicitly states that physicians who provide diagnostic interpretation will be paid only for those claims that confirm a certified CDSS was used.
- Those ordering physicians identified as outliers as measured by CMS in 2018-9 will be subject to a prior authorization process beginning Jan 1 2020.
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