Diagnostic imaging is the fastest growing segment of Medicare spending on physicians' services. Between 1999 and 2003, research from the Medicare Payment Advisory Commission (MedPAC) indicates that the volume of these services grew by 9.9 percent per year on average, nearly twice as fast as all physician services (5.4 percent per year) during this time period, and they grew significantly in complexity as well. This observed growth, both from the Medicare and commercial payer perspectives, has been driven by various factors, including the rapid diffusion of technology, patient demand for services, the practice of "defensive" medicine, and the financial incentives inherent in the payment rates and associated revenues to provide ancillary services.

Given the fiscal implications of imaging service costs and use on the Medicare program and the mission of the Centers for Medicare & Medicaid Services (CMS) to deliver the "right care for every person every time," CMS has undertaken an initiative focused on promoting efficient care. CMS has contracted with The Lewin Group (Lewin), to develop a set of imaging efficiency measures focused on the outpatient place of service.

Measure development is aligned with the system developed by The Quality Measurement and Health Assessment Group (QMHAG). The Measures Management System is a set of standardized business practices and decision criteria developed for CMS to guide the development, implementation, and maintenance of high caliber health care quality measures. The system is documented in a series of procedures collectively referred to as "the Blueprint." Additional measure development information is available at: www.hsag.com/mms

The project team welcomes your feedback through both a survey and free-form comments on any or all of the proposed measures.