Agencies and Programs

Jeffrey P. Kanne

Health-care delivery in the United States is regulated by several governmental agencies that are part of the US Department of Health and Human Services (DHHS). The agencies run a variety of programs that affect public health, individual patients, and individual practitioners. Furthermore, each state, the District of Columbia, and the US territories have medical boards that regulate the practice of medicine within their respective jurisdictions (Table 7.1). Additionally, various health-care delivery programs focused on diagnostic imaging have been developed by professional not-for-profit groups and are targeted to professionals and the general public alike (Table 7.2).

Table 7.1 SUMMARY OF GOVERNMENTAL AGENCIES REGULATING HEALTH CARE.

Agency	Roles
Centers for Medicare and Medicaid Services	Oversee Medicare program Oversee Medicaid programs jointly with respective states
Centers for Disease Control and Prevention	Detect and respond to new public health threats Confront biggest health problems that cause death and disability for Americans Promote disease prevention through science and advanced technology Promote health and safe behaviors, communities, and environments Develop public health leaders and train the public health workforce Assess the health status of the United States
Food and Drug Administration	Ensure safety of US food supply Ensure safety of human and veterinary drugs, vaccines, and other biologic products and medical devices Protect public from electronic product radiation Ensure that cosmetics and dietary supplements are safe and properly labeled Regulate tobacco products Advance public health by helping speed product innovations
State medical boards	Issue licenses to practice medicine Investigate complaints against physicians Supervise and facilitate rehabilitation of impaired physicians

AGENCIES

Centers for Medicare and Medicaid Services

The Centers for Medicare and Medicaid Services (CMS) is an agency in the DHHS. CMS oversees and regulates all federal health-care programs, including Medicare, Medicaid, Children’s Health Insurance Program (CHIP), and Health Insurance Marketplaces. Some programs such as Medicaid, CHIP, and Health Insurance Marketplaces are operated jointly with individual states.

Table 7.2 SUMMARY OF GOVERNMENTAL AND PROFESSIONAL PROGRAMS RELATED TO DIAGNOSTIC IMAGING.

Program	Primary Sponsor	Goal(s)
Imaging 3.0	American College of Radiology	Increase the value of the radiologist to health-care team Improve the quality of health care through appropriate imaging
Image Gently	Image Gently Alliance	Provide safe, high-quality imaging for children while minimizing exposure to ionizing radiation
Image Wisely	American College of Radiology Radiological Society of North America American Society of Radiologic Technologists American Association of Physicists in Medicine	Raise public and professional awareness about the risks and benefits of the use of ionizing radiation in medical imaging Advocate for lowering the amount of ionizing radiation used in medically necessary diagnostic imaging studies Eliminating unnecessary procedures
Choosing Wisely	American Board of Internal Medicine Foundation	Promote conversations between patients and providers regarding value of diagnostic tests, procedures, or treatments in the context of scientific evidence and potential for harm
Accountable Care Organizations	Centers for Medicare and Medicaid Services	Provide high-quality care to Medicare beneficiaries while reducing costs
Medicare and Medicaid Electronic Health Care Record (EHR) Incentive Programs	Centers for Medicare and Medicaid Services	Promote adoption, implementation, expansion, and meaningful use of EHR technology

CMS sets reimbursement rates for medical services provided, including technical and professional fees for imaging studies. Furthermore, CMS’s fee schedules often affect reimbursement rates for local private insurance carriers. CMS requirements also dictate requirements for providers and facilities. For example, CMS requires that all outpatient facilities that bill CMS for the technical component for advanced imaging studies (CT, MRI, and PET) be accredited by an organization with deeming authority.¹

Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC) is a large agency of the DHHS. The CDC is charged with detecting and responding to new and emerging health threats; confronting the biggest health problems that cause death and disability for Americans; using science and advanced technology to prevent disease; promoting health and safe behaviors, communities, and environments; developing leaders and training the public health workforce; and assessing the health status of the United States.²

The CDC provides educational materials for providers and the public on specific diseases, healthy lifestyles, travel risks and recommendations, emergency preparedness, and other public health topics. Furthermore, through the National Center for Health Statistics, the CDC provides a wealth of public health data.

The National Institute for Occupational Safety and Health (NIOSH) is a unit of the CDC that conducts research and makes recommendations to prevent worker injury and illness. NIOSH runs the B Reader Program, which began in 1974 in response to the need to identify physicians qualified to serve in national pneumoconiosis programs directed at coal miners.³ The Federal Mine Safety and Health Act of 1977 mandated the creation of the Coal Workers’ X-ray Surveillance Program, which requires B reader certification for interpreters of worker radiographs. B reader certification is also required for the Asbestos Medical Surveillance Program, which is administered by the Navy and Marine Corps Public Health Center.

Food and Drug Administration

The Food and Drug Administration (FDA) is an agency in the DHHS and is responsible for protecting public health by assuring the safety of the food supply (certain animal products such as meat are regulated by the US Department of Agriculture); ensuring that human and veterinary drugs, vaccines, and other biologic products and medical devices for human use are safe and effective; protecting the public from electronic product radiation; assuring cosmetics and dietary supplements are safe and properly labeled; regulating tobacco products; and advancing public health by helping speed product innovations.⁴ For example, CT and MRI scanners, contrast agents, intravascular catheters, and computer-aided detection (CAD) software all must receive FDA clearance before being routinely implemented in health-care delivery. The FDA also administers the Mammography Quality Standards Act (MQSA) (see Chapter 8).

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