At the beginning of next year, the Centers for Medicare & Medicaid Services (CMS) will require providers and practitioners become compliant with the Protecting Access to Medicare Act (PAMA) to ensure high-quality patient care.

PAMA aims to address waste by mandating the use of a clinical decision support (CDS) tool when ordering advanced imaging services. This mandate is critical to patient care as CDS tools help determine if orders are applicable to guidelines known as appropriate use criteria (AUC) and if they adhere to the guidelines.

In order to ensure that their providers were prepared, Intermountain Healthcare, a Utah-based, not-for-profit system of 24 hospitals with more than 2,400 physicians and advanced practice clinicians, turned to Stanson Health, the newest member of PINC AITM Clinical Intelligence.

What exactly is PAMA, why is it important and what do providers need to do to be compliant with it?

PAMA is designed to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries. This type of imaging includes:

• Computed tomography (CT)
• Positron emission tomography (PET)
• Nuclear medicine
• Magnetic resonance imaging (MRI)

The program requires that healthcare providers consult a CDS tool when ordering advanced diagnostic imaging services for Medicare fee-for-service (FFS) patients. CDS tools help determine if orders are applicable to AUC and if they adhere to the guidelines.

“We’re already seeing change happen in areas similar to the areas these regulations are intended to address – reducing healthcare costs and eliminating waste,” explained James Hellewell, MD, Medical Director, Care Transformation Information Systems at Intermountain Healthcare. “Most of us in healthcare would agree there’s a significant amount of waste, especially in the imaging space. Clinicians are conducting more studies than are necessary. It makes sense that legislation is being enacted and, over time, I think PAMA requirements will increase. Looking to the future, I expect we’ll see a positive outcome on care delivery with PAMA.”

What makes one CDS solution different than the rest?

Providers need a qualified CDS mechanism (qCDSM) that delivers the mandated guidance at the point of order entry. The qCDSM achieves this by recommending the cancellation of studies without strong evidence-based indications for the specific clinical scenario, while also delivering important clinical information to the radiologist for evaluating the studies.

Stanson Health, the newest member of PINC AITM Clinical Intelligence, has developed an innovative, artificial intelligence (AI)-enabled PAMA solution that directly integrates into the EHR workflow and provides clinician recommendations as well as an easy and intuitive user experience. By implementing this PAMA-compliant CDS solution, Intermountain Healthcare is able to leverage data already available in the EHR.

“We assembled a group of both technical and clinical experts within Intermountain to review a number of PAMA solutions we were considering, and it became pretty clear that our clinicians preferred the PINC AITM Clinical Intelligence PAMA solution,” said Hellewell. “The simplified, intuitive user experience was their top reason for favoring PINC AITM. The seamless and automatic integration into our EHR also stood out as an advantage over the other solutions we were looking at.”

Currently in use with more than 200,000 clinicians, PINC AITM Clinical Intelligence’s PAMA solution is designed to deliver this important, clinically relevant information to radiologists with few interruptive alerts.

Simply put, providers and their IT teams should look for a solution that’s helpful—not just required.

It has been documented that 90 percent of U.S. healthcare costs are the direct result of a provider decision. By and large, in their efforts to best care for their patients, some clinicians have a tendency to overtreat, according to studies. This overtreatment has resulted in as much as $200 billion in annual waste.

“Another component unique to PINC AITM Clinical Intelligence’s PAMA solution, is that it’s driven by artificial intelligence,” stated Hellewell. “The technology uses natural language processing and machine learning to digest existing patient data in the EHR and, in some cases, can determine that the AUC for the particular situation has been met and an alert doesn’t need to be generated. This is very valuable to us. Fewer alerts delivered translates into fewer interruptions for our clinicians. They don’t need to spend time adding information to an order or changing an order because the system knows the criteria has been met.”

Now more than ever, providers need a reliable PAMA solution that helps guide care in the EHR workflow, enabling providers to improve quality and cost of care via an easy and intuitive user experience.