Keith D. Hentel, MD, MS; Andrew Menard, JD; John Mongan, MD; Jeremy C. Durack, MD; Pamela T. Johnson, MD; Ali S. Raja, MD, MBA, MPH; Ramin Khorasani, MD, MPH
Acknowledgment: The authors thank Laura E. Peterson for her assistance in the preparation of this manuscript.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0287.
Corresponding Author: Keith D. Hentel, MD, MS, Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY 10065; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Hentel: Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY 10065.
Mr. Menard: Department of Radiology, Johns Hopkins Health System, 601 North Caroline Street, JHOC 4221, Baltimore, MD 21287.
Dr. Mongan: University of California, San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA 94143.
Dr. Durack: Memorial Sloan Kettering Cancer Center, 1275 York Avenue, H118, New York, NY 10065.
Dr. Johnson: Johns Hopkins Medicine, 601 North Caroline Street, Room 3140D, Baltimore, MD 21287.
Dr. Raja: Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.
Dr. Khorasani: Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120.
Author Contributions: Conception and design: K.D. Hentel, A. Menard, J. Mongan, P.T. Johnson, R. Khorasani.
Analysis and interpretation of the data: K.D. Hentel, J.C. Durack, R. Khorasani.
Drafting of the article: K.D. Hentel, A. Menard, J.C. Durack, R. Khorasani.
Critical revision of the article for important intellectual content: K.D. Hentel, A. Menard, J. Mongan, J.C. Durack, P.T. Johnson, A.S. Raja, R. Khorasani.
Final approval of the article: K.D. Hentel, A. Menard, J. Mongan, J.C. Durack, P.T. Johnson, A.S. Raja, R. Khorasani.
Provision of study materials or patients: R. Khorasani.
Administrative, technical, or logistic support: K.D. Hentel, J.C. Durack, R. Khorasani.
Collection and assembly of data: K.D. Hentel, R. Khorasani.
The Appropriate Use Criteria Program, enacted by the Centers for Medicare & Medicaid Services in response to the Protecting Access to Medicare Act of 2014 (PAMA), aims to reduce inappropriate and unnecessary imaging by mandating use of clinical decision support (CDS) by all providers who order advanced imaging examinations (magnetic resonance imaging; computed tomography; and nuclear medicine studies, including positron emission tomography). Beginning 1 January 2020, documentation of an interaction with a certified CDS system using approved appropriate use criteria will be required on all Medicare claims for advanced imaging in all emergency department patients and outpatients as a prerequisite for payment. The Appropriate Use Criteria Program will initially cover 8 priority clinical areas, including several (such as headache and low back pain) commonly encountered by internal medicine providers. All providers and organizations that order and provide advanced imaging must understand program requirements and their options for compliance strategies. Substantial resources and planning will be needed to comply with PAMA regulations and avoid unintended negative consequences on workflow and payments. However, robust evidence supporting the desired outcome of reducing inappropriate use of advanced imaging is lacking.
Hentel KD, Menard A, Mongan J, Durack JC, Johnson PT, Raja AS, et al. What Physicians and Health Organizations Should Know About Mandated Imaging Appropriate Use Criteria. Ann Intern Med. [Epub ahead of print 11 June 2019]170:880–885. doi: 10.7326/M19-0287
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Published: Ann Intern Med. 2019;170(12):880-885.
Published at www.annals.org on 11 June 2019
Emergency Medicine, Healthcare Delivery and Policy.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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