Reactions to the new CMS requirements regarding AUC have been mixed throughout the Imaging industry, to say the least. 

By way of short recap, the new CMS (Centers for Medicare and Medicaid Services) requirements, set to be tested in 2020 and go into effect in January 2021, state that if a Medicare-covered patient:

  1. Is suspected to have any of the following conditions or symptoms: 

Priority Clinical Areas

  • Coronary Artery Disease (suspected or diagnosed)
  • Suspected Pulmonary Embolism
  • Headache (includes traumatic or non-traumatic)
  • Hip Pain
  • Low back pain
  • Shoulder pain (includes suspected rotator cuff)
  • Cervical or Neck pain
  • Cancer of the Lung (Primary or metastatic, suspected or diagnosed)

     2. AND is to be scheduled for an Advanced Imaging Exam (CT, MRI, PET or Nuclear Medicine)

THEN, a physician must consult an approved Clinical Decision Support Mechanism (CDSM) to validate that the imaging exam selected is the most appropriate for the patient.  Not consulting with an approved CDSM risks a decrease in, or a complete refusal of, Medicare reimbursement for the procedure.

The effects of the new requirements

Arguments in favor of using a CDSM reference how wonderful it is to have an evidence knowledge base at one’s fingertips to ensure proper care.  They also argue that doing more testing is not the measurement of good healthcare; but rather, doing the right testing is.  And, of course, Medicare wants to be sure they aren’t paying for the most expensive exam up front, when a less expensive one might have gotten the job done.

The idea makes sense, because we all want to provide excellent care to our patients.  It’s the implementation of that idea that has members of the medical imaging community worried.

For the past two years, a new article about imaging staff burnout seemed to be written every month.    Which shouldn’t surprise us because recent numbers indicate that over a 1/3 of the imaging staff in the US still report high levels of workplace stress and experience feelings of burnout.

Many feel that new CMS requirements regarding CDS mechanisms will do little but place additional burden on both the ordering community as well imaging service providers.  However, medQ’s integrated CDS tool will act to significantly reduce this burden.

Good integration means less interruption

medQ, in partnership with LogicNets, has seamlessly integrated a CDS platform into the Ordering and Scheduling module of the Q/ris 3000 Imaging Workflow as well as in the Q/ris Physician’s Portal. The integration incorporates checks and balances and a streamlined the CDSM consultation process to reduce clicks and ensure our clients remain penalty-free.

During the ordering procedure, the integrated CDS tool automatically flags exams that require CDSM consultation. The physician can then open the CDS window from within the ordering module and use the interactive visual navigation and to walk through the clinical guidelines until they arrive at the appropriate exam.  Upon selecting the exam, the CDS tool closes and the appropriate AUC consultation code is attached to the exam to be carried automatically through to billing, ensuring a prompt and accurate reimbursement.

Using the Q/ris integrated CDS tool can help practices enhance patient safety and easily comply with CMS requirements with minimal workflow interruption.

Preparing for the inevitable

Let’s face it, wide-spread adoption of the AUC CDS mechanism is on the horizon.  CMS is highly-incentivized to push this through as they hope it will reduce the amount overutilization of services.  Other segments of healthcare have adopted various forms of AUC already.

Now is the time to prepare; and if it’s done right, practices can not only minimize the impact, but also add new value.

“Part of being the ‘perfect-fit’ workflow is making sure we stay the perfect fit by helping practices painlessly keep up with changing regulations and requirements.”

John Norman, CEO, medQ

Hands-on demos for the integrated CDS tool will be taking place during RSNA 2019 at the medQ-Vaso Booth #3941.  Schedule a time to stop by.