Agencies and Programs



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




  1. Oversee Medicare program



  2. Oversee Medicaid programs jointly with respective states


Centers for Disease Control and Prevention




  1. Detect and respond to new public health threats



  2. Confront biggest health problems that cause death and disability for Americans



  3. Promote disease prevention through science and advanced technology



  4. Promote health and safe behaviors, communities, and environments



  5. Develop public health leaders and train the public health workforce



  6. Assess the health status of the United States


Food and Drug Administration




  1. Ensure safety of US food supply



  2. Ensure safety of human and veterinary drugs, vaccines, and other biologic products and medical devices



  3. Protect public from electronic product radiation



  4. Ensure that cosmetics and dietary supplements are safe and properly labeled



  5. Regulate tobacco products



  6. Advance public health by helping speed product innovations


State medical boards




  1. Issue licenses to practice medicine



  2. Investigate complaints against physicians



  3. 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




  1. Increase the value of the radiologist to health-care team



  2. 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




  1. Raise public and professional awareness about the risks and benefits of the use of ionizing radiation in medical imaging



  2. Advocate for lowering the amount of ionizing radiation used in medically necessary diagnostic imaging studies



  3. 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



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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Oct 14, 2018 | Posted by in GENERAL RADIOLOGY | Comments Off on Agencies and Programs

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