Imaging Appropriate Use Criteria
December 11, 2019- Beginning in January 2020, the Centers for Medicare and Medicaid Services (CMS) will require documentation of Appropriate Use Criteria (AUC) for outpatient and ED orders for advanced imaging studies. McLaren is implementing a systems-based project to support documentation of AUC for outpatient and ED advanced imaging studies.
WHY: Beginning in January 2020, the Centers for Medicare and Medicaid Services (CMS) will require documentation of Appropriate Use Criteria (AUC) for outpatient and ED orders for advanced imaging studies, which includes CT, MRI, PET and Nuclear Medicine scans. After the 2020 grace period, CMS will not pay for these studies if AUC documentation is not provided with the bill.
While the requirement for documenting AUC is a government mandate, it is important to note that the appropriate use of imaging is already a major goal of the McLaren High Value Care Program. Similar to blood and lab test utilization, the use of advanced imaging is highly variable among providers managing similar patients and the estimated rate of overuse is 20- 50%. Also of concern is that incidental findings (‘incidentalomas’) occur in 22- 38% of advanced imaging studies, which can lead to downstream testing, costs and patient anxiety. Most pertinent to our role as providers is that unnecessary imaging can lead to patient harm through radiation exposure, as CTs deliver radiation dosing that can be hundreds of times greater than plain films.
WHAT: Implement a systems-based project to require documentation of AUC for outpatient and ED advanced imaging studies. Project goals are to support evidence based imaging and to improve imaging stewardship.
Multimodal approach to include three components:
- Education (HVC web site info, posters, pocket cards)
- Audit and feedback (HVC teams, attending physicians, radiologists)
- Clinical decision support using the CareSelect® platform
- Offers point of order guidance in One McLaren Cerner to providers by integrating expert education from the ACR on overutilized and high value imaging exams
- There will also be CareSelect® portal for non-Cerner EHRs.
Dr. McKenna's Letter to Providers
CMS AUC Fact Sheet with Affected CPT Codes
Imaging Appropriate Use Criteria Summary
Choosing Wisely Lists, References & Resources
Ten things physicians and patients should question regarding appropriate use of imaging
Overview of the Centers for Medicare and Medicaid Services (CMS) Imaging Appropriate Use Criteria required under the Protecting Access to Medicare Act (PAMA) of 2014.
American College of Radiology toolkit to improve imaging appropriateness based upon a growing list of imaging Choosing Wisely topics
- Oren, O, Kebebew, E, & Ioannidis, JP (2019). Curbing Unnecessary and Wasted Diagnostic Imaging. JAMA, 321(3), 245–246. https://doi.org/10.1001/jama.2018.20295
- Hong, J, Han, K, Jung, J, & Kim, JS (2019). Association of Exposure to Diagnostic Low-Dose Ionizing Radiation With Risk of Cancer Among Youths in South Korea. JAMA Network Open, 2(9), e1910584. https://doi.org/10.1001/jamanetworkopen.2019.10584
- O’Sullivan, JW, Muntinga, T, Grigg, S, & Ioannidis, JPA (2018). Prevalence and outcomes of incidental imaging findings: umbrella review. BMJ (Clinical Research Ed.), 361, k2387. https://doi.org/10.1136/bmj.k2387
- Litkowski, PE, Smetana, GW, Zeidel, ML, & Blanchard, MS (2016). Curbing the Urge to Image. The American Journal of Medicine, 129(10), 1131–1135. https://doi.org/10.1016/j.amjmed.2016.06.020
- Schneider, E, Zelenka, S, Grooff, P, Alexa, D, Bullen, J, & Obuchowski, NA (2015). Radiology order decision support: examination-indication appropriateness assessed using 2 electronic systems. Journal of the American College of Radiology : JACR, 12(4), 349–357. https://doi.org/10.1016/j.jacr.2014.12.005