Evaluation of the Medicare Imaging Demonstration Project

As part of the Medicare Improvements for Patients and Providers Act of 2008 (P.L. 110-275), Section 135(b) stipulates that the Secretary of Health and Human Services design, implement, manage, and evaluate a demonstration project to assess the appropriateness of advanced diagnostic imaging procedures in the fee-for-service Medicare program. Through the use of decision support systems (DSSs), the demonstration project seeks to quantify rates of inappropriate advanced image ordering and to determine whether exposing physicians to professional guidelines when ordering advanced imaging procedures is associated with more appropriate ordering and a reduction in utilization. The Medicare Imaging Demonstration (MID) aims to recruit up to 5,000 physicians to participate in the 2-year demonstration, slated to begin in January 2011. All physicians in a practice will consult a DSS whenever they intend to order any 1 of 11 advanced imaging procedures involving diagnostic magnetic resonance imaging (MRI), computed tomography (CT), or Single Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT MPI). Based on appropriateness guidelines written by medical specialty societies, the DSS will rate the appropriateness of the order and inform the ordering physician. The physician, though, retains the autonomy to order any imaging procedure deemed necessary; prior authorization is prohibited by statute. The primary purpose of this task order is to evaluate the MID.