Medicare Imaging Demonstration Final Evaluation: Report to Congress

Area of Science:

• Health economics
• Medical imaging utilization
• Healthcare policy

Background:

• Rising costs of advanced medical imaging are a significant factor in overall healthcare spending growth.
• The Centers for Medicare & Medicaid Services (CMS) initiated the Medicare Imaging Demonstration to address this issue.

Purpose of the Study:

• To evaluate the impact of providing ordering clinicians with appropriateness guidelines for advanced imaging.
• To determine if this intervention could reduce the ordering of medically inappropriate advanced diagnostic imaging services.

Main Methods:

• The study analyzed advanced diagnostic imaging utilization trends from January 2009 to November 2013.
• It specifically examined data before, during, and after the Medicare Imaging Demonstration period.
• The effectiveness of decision support systems in assigning appropriateness ratings to imaging orders was assessed.

Main Results:

• The demonstration observed only minor shifts in clinician ordering patterns for advanced imaging.
• Decision support systems faced challenges, failing to assign appropriateness ratings to a substantial number of orders.
• This limitation potentially reduced the overall effectiveness of the decision support intervention.

Conclusions:

• The Medicare Imaging Demonstration identified opportunities for improving decision support systems for advanced imaging.
• Further refinements are needed to enhance the efficacy of such systems in controlling utilization and costs.