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Required decision support for imaging studies starts 2020

21 Jan 2018

By: Mary Ransome, Director of Imaging and Lab Administration

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The Centers for Medicare & Medicaid Services will require all imaging providers to use software that supports imaging decisions starting Jan. 1, 2020.

  • The software is intended to guide the ordering physician to best practice, as determined by the American College of Radiology (ACR), for each patient and diagnosis.
  • In 2021, CMS reimbursement rates will be tied to provider compliance with best practices as measured in 2020.

Decision support will be required for all CT, PET, MRI and nuclear medicine studies. This is a new requirement and will require a change in culture. We want to make the transition as simple as possible.

We are launching the CareSelect decision support software mid-April 2018 for all providers who order in the Salem Health Epic system. It will also be available via a web portal for providers on separate electronic health record systems.

While we are putting the software into place in 2018, provider reimbursement won’t be immediately tied to following ACR best practices. The reimbursements will be tied to compliance starting Jan. 1, 2021, after you have had a chance to understand the new requirements and how it affects your practice.

Between now and April 2018, we will explain these changes in many venues. We’ll help you understand why these changes are happening, what it will look like for the provider, how to use the new system and what the short- and long-term implications are for you. We will present at numerous section meetings, leadership meetings and group practices and publish regular articles in Common Ground.

Why are we implementing imaging decision support software?

While this is a government regulatory requirement, this software supports Salem Health’s overarching goal to provide the right study at the right time. The reality is that over prescription of high-level imaging is a problem, resulting in extra costs to the patient and unnecessary exposure to radiation.

  • At Salem Health, outpatients with lower back pain are seven percent more likely than the national average to receive a CT or MRI without first referring the patient to recommended treatments first, such as physical therapy. Our goal is to reduce the amount of radiation to which patients are exposed and unnecessary costs to the patients.
  • Organizations who have used this software have seen significant improvements. At Virginia Mason, MRIs for lower back pain dropped 23.4 percent. CT orders for sinusitis dropped 26.8 percent and MRIs for headaches dropped 23 percent. Some organizations experienced an overall decline, while others saw volumes shift between imaging modalities.

Thank you for your understanding and flexibility as we adjust to this regulatory requirement. Look for further information in the coming weeks, and feel to reach out to if you have any questions.