June 23, 2016 — The Centers for Medicare & Medicaid Services (CMS) has named the American College of Radiology (ACR) a “qualified Provider-Led Entity” (qPLE) approved to provide appropriate use criteria (AUC) under the Medicare Appropriate Use Criteria program for advanced diagnostic imaging. This means that medical providers can consult ACR Appropriateness Criteria to fulfill impending Protecting Access to Medicare Act (PAMA) requirements that they consult AUC prior to ordering advanced diagnostic imaging for Medicare patients.
Appropriateness criteria use has been shown to improve quality, reduce unnecessary imaging and lower costs. ACR Appropriateness Criteria, in existence for more than 20 years, define national guidelines for the most appropriate medical imaging exam for a patient’s condition, if any imaging is needed at all. These comprehensive criteria cover 215 topics and more than 1,080 clinical indications.
ACR Select, licensed by National Decision Support Company (NDSC), contains the digital version of the ACR Appropriateness Criteria diagnostic topics. This platform can be integrated with all major computerized ordering or electronic health record (EHR) systems to guide providers when ordering medical imaging scans. ACR Appropriateness Criteria, via ACR Select, are freely available to all physicians via the ACR Select web portal. The ACR Select delivery platform provided by NDSC also delivers AUC published by other PLEs or criteria sources.
Under PAMA, CMS will soon require consultation of appropriate use criteria developed by a qPLE in the ordering of advanced diagnostic imaging exams (computed tomography, magnetic resonance imaging, nuclear medicine including positron emission tomography) as a condition for reimbursement to imaging providers. Only a small number of qPLEs have been approved. Appropriateness criteria-based clinical decision support systems help improve care quality and appropriateness without delaying needed care the way that costly and inefficient imaging prior-authorization programs often can.
To help referring providers and radiologists become familiar with appropriateness criteria-based clinical decision support systems, the ACR is administering the CMS-funded Radiology Support, Communication and Alignment Network (R-SCAN). R-SCAN is a collaborative action plan that brings radiologists and referring clinicians together to improve imaging appropriateness.
For more information: www.acr.org