Nav: Home

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

Related Physicians Articles:

Types and distribution of payments from industry to physicians
In 2015, nearly half of physicians were reported to have received a total of $2.4 billion in industry-related payments, primarily involving general payments (including consulting fees and food and beverage), with a higher likelihood and value of payments to physicians in surgical than primary care specialties and to male than female physicians, according to a study published by JAMA in a theme issue on conflict of interest.
Is higher health care spending by physicians associated with better outcomes?
Higher health care utilization spending by physicians was not associated with better outcomes for hospitalized Medicare beneficiaries in a new article published online by JAMA Internal Medicine.
Time for physicians to prepare for impending appropriate use mandate
Within a year, the Centers for Medicare & Medicaid Services (CMS) will implement a provision in the Protecting Access to Medicare Act that requires physicians to consult appropriate use criteria using CMS-approved computer-based clinical decision support mechanisms when ordering advanced imaging procedures.
Four Loyola physicians named to Who's Who in Hispanic Chicago
Four Loyola Medicine physicians have been named to Negocios Now's 2016 'Who's Who in Hispanic Chicago.' Loyola has more physicians on the list than any other medical center.
Physicians are more likely to use hospice and intensive care at end of life
New research suggests that US physicians are more likely to use hospice and intensive or critical care units in the last months of life than non-physicians.
Professional burnout associated with physicians limiting practice
At a time when the nation is facing projected physician shortages, a Mayo Clinic study shows an association between burnout and declining professional satisfaction with physicians reducing the number of hours they devote to clinical practice.
By asking, 'what's the worst part of this?' physicians can ease suffering
When patients suffer, doctors tend to want to fix things and if they cannot many doctors then withdraw emotionally.
Physicians in training at high risk for depression
New research from Brigham and Women's Hospital finds that 28.8 percent of trainees screen positive for depression during their residency.
Physicians and burnout: It's getting worse
Burnout among US physicians is getting worse. An update from a three-year study evaluating burnout and work-life balance shows that American physicians are worse off today than they were three years earlier.
American College of Physicians urges physicians to oppose mass deportation
The American College of Physicians (ACP) today called on physicians, individually and collectively, to speak out against proposals to deport the 12 million US residents who lack documentation of legal residency status, citing the adverse impact that mass deportation would have on individuals and the health of the public.

Related Physicians Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Climate Crisis
There's no greater threat to humanity than climate change. What can we do to stop the worst consequences? This hour, TED speakers explore how we can save our planet and whether we can do it in time. Guests include climate activist Greta Thunberg, chemical engineer Jennifer Wilcox, research scientist Sean Davis, food innovator Bruce Friedrich, and psychologist Per Espen Stoknes.
Now Playing: Science for the People

#527 Honey I CRISPR'd the Kids
This week we're coming to you from Awesome Con in Washington, D.C. There, host Bethany Brookshire led a panel of three amazing guests to talk about the promise and perils of CRISPR, and what happens now that CRISPR babies have (maybe?) been born. Featuring science writer Tina Saey, molecular biologist Anne Simon, and bioethicist Alan Regenberg. A Nobel Prize winner argues banning CRISPR babies won’t work Geneticists push for a 5-year global ban on gene-edited babies A CRISPR spin-off causes unintended typos in DNA News of the first gene-edited babies ignited a firestorm The researcher who created CRISPR twins defends...