PAMA New Year’s 2020: Did everything get brought to the party?

Excerpt

High-value healthcare requires an association of collaborators to work together to improve care, health, and costs of care by identifying, testing, and disseminating best practice care and corresponding payment models. In recent years, data have emerged identifying high healthcare costs in the USA related to an overuse of diagnostic imaging.1 With approximately 17.8% of gross domestic product spent on health care in the USA, and the second highest number of imaging scans performed, it is estimated that approximately $100 billion per year is spent on diagnostic imaging.1,2 In response to this trend, cardiovascular societies have undertaken extensive efforts to target appropriate utilization of diagnostic imaging services, most prominently creation and refinement of Appropriateness Use Criteria (AUC).3,4 In addition to this robust response by the Cardiology community, legislation was passed over the past two years entitled: Protecting Access to Medicare Act (PAMA) of 2014, Section 218(b). This act established a new program to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries and mandated from January 1, 2020 that providers must consult and document AUC via qualified clinical decision support mechanisms (CDSM) when ordering such modalities for Medicare Part B patients. These modalities include computed tomography (CT), positron emission tomography (PET), single-photon emission tomography (SPECT), and magnetic resonance imaging (MRI). The goal of this program is to reduce unnecessary cardiac imaging and the downstream cascade of invasive procedures, which have been shown to be costly, unsustainable, and low-yield in inappropriate circumstances. …