Clinical Decision Support (CDS) for imaging using Appropriate Use Criteria (AUC) has the potential to reduce unnecessary imaging and improve overall diagnostic approaches leading to better patient care. The use of CDS when ordering advanced imaging for Medicare patients has been mandated by Congress as part of the Protecting Access to Medicare Act of 2014 (PAMA 2014). This requirement will take effect on January 1, 2022.
Additional information on the CMS AUC program may be found on the CMS website
The program is summarized in the Annals of Internal Medicine:
“What Physicians and Health Organizations Should Know About Mandated Imaging Appropriate Use Criteria.” Ann Intern Med. 2019 Jun 18;170(12):880-885.
The program requires AUC cover at a minimum eight priority clinical areas (PCA) : Headache (Traumatic & Non-Traumatic), Neck Pain (Traumatic & Non-Traumatic), Shoulder Pain, Hip Pain, Lung Cancer, Suspected Pulmonary Embolism, Suspected Coronary Artery Disease, and Low Back Pain.
The Centers for Medicare & Medicaid Services (CMS) have designated specific organizations that are able to create AUC. These organizations are referred to a qualified Provider Led Entities (PLE’s). In recognition of Weill Cornell’s experience with CDS and the expertise of our Physician-Researchers, Weill Cornell has been qualified as a PLE to develop AUCs.
When placing orders for advanced imaging, providers need to consult a Qualified Decision Support Mechanism (QDSM). These may be integrated with your Computerized Order Entry (COE) or available as stand alone systems.
For the CMS AUC program, Weill Cornell has created AUC for the following:
These AUC are available on this website including the current version of the AUC, members of the subspecialty panel(s) that contributed to the AUC, any conflicts of interest that members may have, references to the scientific literature used in developing the AUC, and a grading of the evidenced based recommendation. Weill Cornell has adopted two evidenced based grading systems: Oxford and CODUS.
Weill Cornell has partnered with the Harvard Library of Evidence to assist us with the curation of the AUCs and grading. Additional information on the Harvard Library of Evidence may be found at:
https://libraryofevidence.hms.harvard.edu/
Weill Cornell AUC are intended to be guidelines and do not apply to every individual patient or patient presentation. They are not considered to be a substitute for your experience or knowledge of your patients.
Providers will not be penalized for specific cases that do not agree with the recommendations provided by our AUC. In the future, CMS may look at providers who are true outliers in regard to appropriateness of imaging.
If your patients have questions about the AUC program, patient information including Frequently Asked Questions is available on our For Patients page.
Weill Cornell is always looking to improve our AUC. Please provide any feedback at:
