According to a report published online on Nov. 11 by the online publication AuntMinnie.com, the Centers for Medicare and Medicaid Services (CMS) has postponed its January 1, 2017 deadline for physicians to use clinical decision support (CDS) software, based on appropriate-use criteria (AUC), when ordering diagnostic imaging tests.
The report, by AuntMinnie staff writer Erik L. Ridley, stated that, “In an announcement included in the final rule of the Medicare Physician Fee Schedule (MPFS) on October 30, CMS indicated that it now doesn't expect to have approved CDS "mechanisms" until approximately the summer of 2017. The agency said it was not yet in a position to predict the exact timing of a new deadline for when practitioners are expected to begin utilizing clinical decision support.”
Signed into law in April 2014 by President Obama, the Protecting Access to Medicare Act (PAMA) included a mandate that physicians utilize appropriate use criteria via clinical decision support for ordering advanced imaging studies such as diagnostic MRI, CT, and nuclear medicine (including PET). X-ray, fluoroscopy, and ultrasound exams were excluded. The appropriate use criteria requirements also only apply to outpatient settings such as physician offices, hospital outpatient departments, ambulatory surgical centers, and any provider-led outpatient setting.
PAMA had an aggressive timeline. After a series of planned milestones laid out for CMS to approve qualified appropriateness use criteria as well as clinical decision-support mechanisms, all ordering professionals in the Medicare program were mandated, by January 1, 2017, to consult with a qualified CDS mechanism when ordering an advanced imaging study.
PAMA also has reporting requirements for radiologists. By January 1, 2020, outlier professionals -- those who have low adherence to AUC criteria when ordering imaging studies -- will be required to obtain prior authorization.
But the aggressive approach at CMS may not have been realistic. The agency agreed with several commenters that the January 1, 2017, deadline wasn't feasible, and instead CMS chose to delay the implementation date.
Healthcare Informatics will update readers on this story as new developments emerge.