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Time for physicians to prepare for impending appropriate use mandate

February 27, 2017

1. Time for physicians to prepare for impending appropriate use mandate

Most cardiac imaging procedures will be subject to scrutiny under PAMA

Abstract: http://annals.org/aim/article/doi/10.7326/M16-2673

URL goes live when the embargo lifts

Within a year, the Centers for Medicare & Medicaid Services (CMS) will implement a provision in the Protecting Access to Medicare Act (PAMA) that requires physicians to consult appropriate use criteria (AUC) using CMS-approved computer-based clinical decision support mechanisms when ordering advanced imaging procedures. Under PAMA, providers will have to submit proof that applicable AUC were consulted to have their claims processed. After the CMS collects 2 years of data, "outlier" physicians will subject to prior authorization, thus possibly limiting patients' and physicians' access to advanced imaging procedures. Because coronary artery disease evaluation is a priority clinical area, most cardiac imaging procedures will be subject to the initial rollout of the mandate.

Once PAMA is implemented, the burden of reducing inappropriate use will move largely from payers to providers. In preparation for this shift, physicians will need to be educated about expectations under PAMA, which should include increasing their understanding of appropriate use. This will require close collaboration between professional societies representing referring providers and imaging specialists and involvement of all stakeholders.
-end-
Note: For an embargoed PDF, please contact Cara Graeff. To interview the author, Rami Doukky, MD, MSc, please contact Monifa Thomas at mjthomas@cookcountyhhs.org or 312-520-7098.

Also new in this issue:

Annals Understanding Clinical Research: Implications of Missing Data Due to Dropout

Joshua M. Liao, MD; Catharine B. Stack, PhD

Research and Reporting Methods

Abstract: http://annals.org/aim/article/doi/10.7326/M17-0195

American College of Physicians

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