In less than a year, the Protecting Access to Medicare Act (PAMA) – aiming to address waste and ensure high-quality patient care – will go into effect and with it the requirement that providers use a clinical decision support (CDS) tool when ordering advanced imaging services for Medicare fee-for-service (FFS) patients. These include orders for computed tomography, positron emission tomography, nuclear medicine and magnetic resonance imaging.
CDS tools help determine if orders are applicable to guidelines known as appropriate use criteria (AUC) and if they adhere to the guidelines. Beginning Jan. 1, 2022, providers unable to furnish proof that a CDS solution is in place may face payment withholding from the Centers for Medicare & Medicaid Services (CMS) for these services.
Recently, I spoke with James Hellewell, M.D., Medical Director, Care Transformation Information Systems at Intermountain Healthcare, about PAMA and the steps his organization is taking to prepare.
Scott Weingarten M.D., MPH Chief Clinical and Innovation Officer at Premier: How do you see PAMA impacting care delivery in the future?
James Hellewell: We’re already seeing change happen in areas similar to the areas these regulations are intended to address – reducing healthcare costs and eliminating waste. Most of us in healthcare would agree there’s a significant amount of waste, especially in the imaging space. Clinicians are conducting more studies than are necessary. It makes sense that legislation is being enacted and, over time, I think PAMA requirements will increase.
Looking to the future, I expect we’ll see a positive outcome on care delivery with PAMA. If we do, there will be momentum in the industry to drive the successes forward even more. On the other hand, if we don’t see a positive outcome, we’ll need to reconsider what’s happening and think of different ways to address the issues of expense and waste in healthcare.
Scott: What changes in clinician behavior will be important to delivering high-quality, cost-effective care in the imaging space?
James: When it comes to delivering high-quality, cost-effective care in the imaging space, clinicians come up against challenges in two critical areas: staying up to date on the latest evidence and avoiding negative, unintended consequences of over-imaging, such as complications from radiation. It’s important for clinicians to keep their minds open and recognize there’s an issue here. We have to understand that there are tools, like CDS, to guide our decision-making and help us do our jobs better.
Scott: How is Intermountain Healthcare addressing PAMA requirements?
James: We’re responding to PAMA by partnering with Stanson Health, a Premier company, and utilizing its PAMA-compliant CDS solution. Stanson’s CDS technology integrates directly into our health system’s electronic health record (EHR) workflow, providing our clinicians with best practices and guidance around ordering imaging studies at the point of order entry.
The technology determines a set of clinical details for the particular order and offers suggestions if it seems the clinician ought to be using a different imaging study that would be more accurate or not using an imaging study at all.
Scott: Why did you choose to implement Stanson’s CDS solution?
James: We assembled a group of both technical and clinical experts within Intermountain to review a number of PAMA solutions we were considering, and it became pretty clear that our clinicians preferred the Stanson CDS solution. The simplified, intuitive user experience was their top reason for favoring Stanson. The seamless and automatic integration into our EHR also stood out as an advantage over the other solutions we were looking at.
Another component unique to Stanson’s CDS is that it’s driven by artificial intelligence (AI). The technology uses natural language processing (NLP) and machine learning (ML) to digest existing patient data in the EHR and, in some cases, can determine that the AUC for the particular situation has been met and an alert doesn’t need to be generated. This is very valuable to us. Fewer alerts delivered translates into fewer interruptions for our clinicians. They don’t need to spend time adding information to an order or changing an order because the system knows the criteria has been met.
Scott: What outcomes is Intermountain Healthcare hoping to achieve? What are you most looking forward to with the Stanson partnership?
James: As I mentioned earlier, we do believe there’s a problem with over-imaging. And we know there are opportunities to remove waste and reduce costs. One of the ways we can accomplish this is by cutting down on unnecessary procedures. So, over time, we want to see improvements in waste and costs in our outcomes data. We’re pretty confident the Stanson CDS solution will help us realize these benefits.