On May 27, 2009, CMS is holding a Special Open Door Forum on the MIPPA Medicare Imaging Demonstration Project on Appropriate Use of Imaging Services. CMS is seeking input regarding the design and development of the demonstration project. Interested parties can attend the event in person or by phone. CMS priority topics for the forum are listed after the jump.

CMS is particularly interested in the following topic areas:

1. Demonstration Framework:

  • Given that prior authorization is excluded from the demonstration by legislative mandate, how can we best design the demonstration to test both point of order (POO) and point of service (POS) systems?
  • How could CMS assess the impact of POO and POS systems through randomized designs or other comparative models?
  • What will motivate physician participation in the demonstration? How should physicians be recruited? What is the role of economic and non-economic incentives in encouraging participation?

2. Point of Order (POO) and Point of Service Systems (POS):

  • What are the major characteristics of POO and POS? How are they similar and how are they different in their assessments of appropriateness? How are these systems currently used by providers and payers?
  • What data are captured by the systems and what is the comparability in data elements across systems? Are there distinctions in how appropriateness of individual procedures is assessed between these two systems?
  • Does use of POO versus POS systems vary systematically by type of service, service setting, type of physician, and/or geography? How common is the use of these systems by specialists, primary care physicians and performing physicians?
  • How do ordering and performing physicians interface with the POO or POS systems? Do individual physicians or group practices use of more than one system?

3. Imaging Procedures:

  • Specific procedures being considered for inclusion in the demonstration are likely to be high in volume, high in growth, exhibit geographic variation, and have consensus around clinical guidelines. Are there other criteria we should consider when selecting procedures for inclusion in the demonstration?
  • What procedures that have the characteristics described above have been incorporated into POO and POS?
  • Should the demonstration focus on applying a decision support system for only specific types of imaging procedure use (e.g., MRI for Lumbar Spine, rather than all MRIs)? Might a focus on only specific types of procedures cause confusion for physicians or increase burden on physicians?