7 things you need to know now about appropriate use and clinical decision support

For physicians who treat Medicare patients, everything changes next New Year’s Day.

That’s when real consequences begin to befall those who order advanced imaging—CT, MRI or PET scans—without first consulting appropriate use criteria (AUC). They’ll need to show they did so by using a CMS-qualified clinical decision support mechanism (qCDSM).

The ordering physician is not required to go along with the CDSM’s recommendations. He or she just needs to show that a mechanism was consulted. Still, the development represents a big and binding step in the evolution of medical reimbursement in the U.S.

This didn’t come from out of the blue. Medicare’s AUC program is a linchpin...