Medicare Imaging Demonstration

The goal of the demonstration was to collect data regarding physician use of advanced diagnostic imaging services to determine the appropriateness of services in relation to medical specialty guidelines.

Background

The 2-year demonstration, authorized by section 135(b) of the Medicare Improvements for Patients and Providers Act of 2008, examined appropriateness of services across a range of geographic areas, physician specialties, and practice settings in the Medicare fee-for-service (FFS) program; (but it will not include the Medicare Advantage program). The demonstration tested whether the use of decision support systems (DSS) could improve quality of care and reduce unnecessary radiation exposure by promoting appropriate ordering of advanced imaging services. The law specifically excluded any approaches that would require prior authorization.

Initiative Details

A wide variety of interested parties were eligible to apply as conveners or in collaboration with other organizations to perform the responsibilities specified in the demonstration. Examples of conveners included, but are not limited to, physician groups, integrated health care delivery systems, independent practice associations, radiology benefit managers, health plans, information technology vendors, medical specialty societies, and collaborations among the above parties.

Eleven advanced imaging procedures — Spect MPI, MRI lumbar spine, CT lumbar spine, MRI brain, CT brain, CT sinus, CT thorax, CT abdomen, CT pelvis, MRI Knee, and MRI shoulder — were included in the demonstration. The 11 tests were selected based on high expenditures and utilization in the Medicare fee-for-service population and the availability of relevant medical specialty appropriateness guidelines. The law required that the appropriateness criteria used in the demonstration be based on those developed or endorsed by medical specialty societies.

CMS solicited proposals from interested parties (referred to as “conveners”) that recruited physician practices for participation in the demonstration. Those conveners selected were the Brigham & Women's Hospital; Henry Ford Health System; Maine Medical Center-Physician Hospital Organization; University of Wisconsin-Madison, and National Imaging Associates.

Additional Information