Message from Mark Shapiro, MD, Chief of Radiology
Effective January 1, 2020, federal regulations require all providers to consult a CMS-approved Clinical Decision Support Mechanism (CDSM) when ordering certain imaging studies. CDSMs are electronic portals that access appropriate use criteria (AUC) and are being mandated by the federal government in an effort to improve quality of care, patient safety and resource utilization.
This requirement will have an impact on your workflow, and your decisions may have an impact on a patient’s insurance coverage for these services. Englewood Health has been planning for this change and is committed to supporting you with tools and resources to ensure compliance and minimize provider and patient frustration. We have integrated the CDSM CareSelect Imaging into Epic, which uses the American College of Radiology appropriate use criteria.
What providers and patient orders are affected?
This requirement affects all Englewood Health medical staff, including referral staff, who order the following outpatient imaging studies (inpatient orders are not affected):
- Nuclear medicine
All imaging centers will be required to document your compliance with clinical decision support, including Englewood Hospital’s Berrie and Main Radiology, ED, Advanced Medical Imaging in Emerson, Magnus Imaging in Glen Ridge, and our Cardiac Imaging Centers in Fair Lawn, Woodland Park, and Pompton Plains.
What does the provider need to do?
When you order an applicable study in Epic directly, CareSelect Imaging, our clinical decision platform, will automatically be consulted and the system will prompt you with a Best Practice Advisory if the order does not satisfy appropriate use criteria. This functionality is already in place, and newly deployed for nuclear cardiology studies, and your workflow should not change significantly as a result of this new regulation.
If you write orders in another (office-based) EMR or on paper, you must consult decision support if your current EMR has an integrated solution and/or to access one of the approved web portals. The
Decision Support Number that is generated by the CDSM within your office system or on the available web portals must be included on the prescription. To help our providers in complying with this federal mandate, we will also be deploying Epic solutions for outpatient order-entry, which will capitalize on the built-in functionality for clinical decision support. In addition, entering orders directly into Epic may allow you to pull patient demographics from our database, thereby streamlining the order entry process. For more information about this option, contact Asad Ahmad at 201-608-2864.
What is the timeline?
The program goes into effect on January 1, 2020. Year 1 is an education and testing period. During year 1, we expect providers to comply by providing a Decision Support Number on all affected prescriptions. In year 2, coverage may be denied. To prepare for the second year, patients who present for an advanced imaging procedure beginning October 1, 2020, must have a decision support number on their prescriptions or they will not be scheduled for services. The patient will need to return to your office for a new prescription with the required information.
How can I get support using the CDSM?
Englewood Health is here to support our providers during this transition. A successful implementation will help ensure that patients get the right care at the right time and further our commitment to care for the communities we serve. For additional assistance, contact Asad Ahmad at 201-608-2864.