A tiny portion of the Protecting Access to Medicare Act of 2014 is likely to have more impact on radiology practice than any of the cutting edge research presented this week at RSNA 2014.

That is the view of Curtis Langlotz, M.D., a radiology professor and bioinformaticist at Stanford University Medical Center, who spoke at an RSNA panel on the future of federal health information technology incentive programs.

Langlotz warned that for the first time, the Centers for Medicare and Medicaid Services is going to be in a position to control medical imaging utilization by declining to pay for inappropriate imaging studies. "The law will require all of us to pay attention to clinical decision support within a couple of years."

The law requires the adoption of decision support systems that analyze radiology orders for appropriate use criteria, initially determined via a two-year demonstration project that involved several large health care organizations and wound up in 2013.

Langlotz expects HHS will finalize criteria next year, and by the spring of 2016 will certify a list of decision support systems that can rate the consistency of an order with the appropriate use criteria. To document that the radiologist has received the decision support feedback, the systems must supply an ID number for the study.

Starting in January 2017, that ID number has to be included in bills sent to Medicare...or else.  "This is not like meaningful use or PQRI, where you get a little haircut," said Langlotz, referring to reimbursement reductions connected with failure to participate in federal incentive programs for EHR adoption and quality improvement. "You won't get paid at all."

In addition, up to five percent of providers who have the lowest AUC compliance will be required to seek prior authorization for procedures on Medicare patients. The program hasn't previously required any prior authorization.

The panel also included Doug Fridsma, M.D., recently departed from the Office of the National Coordinator for HIT and now the CEO and president of the American Medical Informatics Association. "Now that I no longer work for the government, I can say things that I've been thinking," he said.

Among those things:

* The federal meaningful use program will not be the primary driver of adoption and innovation in health IT now that it's achieved the Stage 1 objective of wide adoption. Fridsma says the ONC was under presidential pressure to get billions in incentive money out into the economy as quickly as possible. “The vice president called and said 'Unless you spend this money, we are going to use it to build bridges,'" Fridsma said. “If we had waited ten years to get that money out, it would have gone away." Ironically, as the meaningful use criteria get more complicated and harder to achieve, the incentive payments are going down. But Fridsma says pressures from other quarters should motivate providers to adopt advanced IT.

* Keep an eye on the Department of Defense's EHR acquisition project, which will cost $11 billion over the next ten years and is required to conform to meaningful use criteria. "If you think about the number of interactions we have with veterans and the VA, the requirements are going to impact all the other electronic health record systems out there," Fridsma said.

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