Radiologists’ comment period ends Friday on proposed Medicare quality criteria for imaging

Radiologists and other interested parties have until Dec. 14, the end of a 30-day comment period, to express opinions about new imaging efficiency measures proposed for Medicare.

The Centers for Medicare and Medicaid Services contracted with L&M Policy Research and its partners National Imaging Associates, an imaging utilization management company, and the Lewin Group, healthcare consultants, to develop the preliminary list of quality standards:

• MRI lumbar spine for low back pain: percentage of studies without evidence of conservative therapy
• mammography follow-up rates, part 1: percentage of patients who receive a diagnostic mammogram or breast ultrasound exam within 45 days of screening mammography
• mammography follow-up rates, part 2: percentage of diagnostic mammography or breast ultrasound exams performed within five days of a screening mammogram
• use of contrast for abdominal CT: percentage of abdominal CT studies for certain indications performed without a contrast medium
• use of contrast for thoracic CT: percentage of CT of thorax with a contrast medium

CMS invited interested parties to take a standardized survey.

CMS plans to eventually link compliance with such quality measures with its coverage of diagnostic imaging services. It noted on the survey website that diagnostic imaging's dubious distinction as the fastest growing segment of Medicare spending on physicians' services led to the proposed standards. The volume of diagnostic imaging services covered by Medicare grew 9.9% per year, nearly twice as fast as the 5.4% rate for all physician services, from 1999 to 2003, according to Medicare advisory group MedPac.

The Institute of Medicine's report

Crossing the Quality Chasm

(Berwick 2002), supplied additional motivation for the proposed standards, according to Dr. Robert Pyatt, a member of the American College of Radiology's metrics committee. The institute recommended improvements in six dimensions of healthcare performance, including efficiency and waste avoidance. "CMS is focused on value and believes there must be the link between quality and efficiency to get value," Pyatt said. Based on discussion with CMS officials, Pyatt expects that CMS will deal with quality standards deliberately. Several additional testing phases are planned, and implementation is not expected soon. The ACR has submitted a coordinated response to CMS including comments recruited from members. It gathered input from various committees and commissions in early December, Pyatt said.For more information from the Diagnostic Imaging archives:

FDA panel recommends adding stereotactic breast biopsy to quality standards program

'Scientific management' takes over radiology

ACR solicits comments to bolster Medicare pay-for-performance program