The U.S. Centers for Medicare and Medicaid Services (CMS) continues to keep its eye on imaging utilization: The agency is planning a meeting for January 31 to discuss whether to add new imaging exams to a data reporting program designed to track overutilization.
CMS said it is exploring whether to add several more types of imaging studies to its Hospital Outpatient Quality Data Reporting program. The agency plans to solicit input on the proposal via a special listening session to be held January 31.
The move is part of CMS' continuing effort to promote more efficient imaging services for Medicare beneficiaries and, therefore, reduce unnecessary imaging, the agency said in an announcement about the session. CMS has developed a set of "imaging efficiency measures" that can help the agency determine whether a site's utilization of a particular imaging technology is inefficient.
Hospitals are required to submit quality measures data to the agency to be paid in full each year via the Outpatient Prospective Payment System (OPPS) schedule for outpatient services provided.
In its 2010 OPPS update, CMS adopted four claims-based imaging efficiency measures: MRI lumbar spine for low back pain, mammography follow-up rates, use of contrast in abdominal CT, and use of contrast in thoracic CT. In its 2011 update (which will go into effect in 2012), CMS included three more: cardiac imaging for preoperative risk assessment for noncardiac low-risk surgery, simultaneous use of brain CT and sinus CT, and use of brain CT in the emergency department for atraumatic headache.
During the listening session, CMS will solicit input on the following:
- Which other imaging procedures would be appropriate candidates for efficiency measures
- Whether there are certain diseases that should be examined from the perspective of imaging use for diagnosis
- Whether CMS should examine imaging efficiency not just in hospitals but in other settings such as independent diagnostic testing facilities (IDTFs) or physician offices
Whether hospitals participate in the Hospital Outpatient Quality Data Reporting program is their own call, according to the American College of Radiology's director of metrics, Judy Burleson. But if they don't, there is a penalty.
"If a hospital decides not to participate in the program, it will receive a 2% downward payment adjustment on [the included exams]," she told AuntMinnie.com. "But the [quality data reporting measures themselves] don't lead to direct reduction in payments for imaging procedures. How a hospital implements this reduction in payment -- whether it would trickle down to radiology or not -- would be its own decision."
By Kate Madden Yee
AuntMinnie.com staff writer
January 25, 2011
Related Reading
CMS issues MPFS conversion update, January 4, 2011
CMS posts final MPFS, HOPPS rules for 2011, November 12, 2010
CMS proposes 2.15% increase in HOPPS, July 14, 2010
CMS pitches 90% use rate in proposed 2010 MPFS rule, July 1, 2009
CMS to raise hospital outpatient payments 3%, July 8, 2008
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