MMC Physician-Hospital Organization Selected
For Medicare Imaging Demonstration
Demonstration project promotes appropriate utilization of advanced imaging services
(Portland, ME) February 11, 2011 - The MMC Physician-Hospital Organization has been selected by the Centers for Medicare & Medicaid Services as a convener in the Medicare Imaging Demonstration, a demonstration project that promotes appropriate utilization of advanced imaging services. CMS solicited proposals from interested parties (referred to as "conveners") that recruited physician practices for participation in the demonstration.
Twenty Maine physician practices and more than 500 physicians in diverse practice settings agreed to participate as part of the MMC PHO demonstration site. CMS awarded $1.4 million to the MMC PHO to fulfill obligations of the demonstration agreement.
Other partners for the demonstration project in Maine include MaineHealth, Maine Medical Center information services, Spectrum Medical Group and InterMed/NovaHealth.
The MMC PHO is in a strong position to implement the demonstration given its relationships with physicians and proven track record in implementing quality and cost-management initiatives. "We believe that the knowledge gained through this demonstration project will benefit patients by improving the quality of care they receive and by reducing unnecessary exposure to radiation," said Jeffrey Aalberg, M.D., MaineHealth's project director for the demonstration.
"The demonstration provides CMS an opportunity to test whether the use of decision support systems can improve quality of care by diminishing patient exposure to potentially harmful radiation caused by unnecessary over-utilization of advanced imaging services," added CMS Administrator Donald Berwick, M.D.
The 2-year demonstration, authorized by section 135(b) of the Medicare Improvements for Patients and Providers Act of 2008, will assess the impact that decision support systems used by physician practices have on the appropriateness and utilization of advanced medical imaging services ordered for beneficiaries in original fee-for-service Medicare.
The demonstration focuses on three advanced diagnostic imaging modalities: magnetic resonance imaging, computed tomography, and nuclear medicine. Eleven advanced imaging procedures - Spect MPI, MRI lumbar spine, CT lumbar spine, MRI brain, CT brain, CT sinus, CT thorax, CT abdomen, CT pelvis, MRI Knee, and MRI shoulder - are included in the demonstration.
Eleven tests were selected based on high spending and utilization in the beneficiary population covered by original Medicare and the availability of relevant medical specialty appropriateness guidelines. The appropriateness criteria used in the demonstration will be medical specialty guidelines that are developed or endorsed by medical specialty societies. The decision support systems provide immediate feedback to the physician about the appropriateness of the test ordered for the patient. The law specifically excludes any approaches that would require prior authorization. The demonstration has no impact on Medicare coverage or payment policies. Demonstration participants will be paid for data.
Additional information about this demonstration can be found at:
Questions on this demonstration may be submitted to CMS at:
About the MMC Physician-Hospital Organization
The MMC Physician-Hospital Organization is a nonprofit organization incorporated in 1994. More than 1,000 physicians in the Community Physicians of Maine partner with Maine Medical Center, with the shared goal of delivering high-quality, cost-effective healthcare to the communities they serve.
MaineHealth is a not-for-profit family of leading high-quality providers and other healthcare organizations working together to make their communities the healthiest in America. Ranked among the nation's top 100 integrated delivery networks, MaineHealth includes the following member organizations: LincolnHealth (Miles Memorial Hospital and LincolnHealth – St. Andrews Campus & Healthcare Center), Maine Medical Center, Maine Mental Health Partners (Spring Harbor Hospital), Pen Bay Healthcare (Pen Bay Medical Center), Southern Maine Medical Center, Waldo County Healthcare (Waldo County General Hospital), Western Maine Health (Stephens Memorial Hospital), HomeHealth Visiting Nurses, Maine Physician Hospital Organization, NorDx and Synernet. Affiliates of MaineHealth include MaineGeneral Medical Center, Mid Coast Hospital, New England Rehabilitation Hospital and St. Mary's Regional Medical Center.
Contact: Jeffrey Aalberg, M.D.