Arye Blachar MD, Abstract Co-Author: Nothing to Disclose

Sigal Tal MD, Presenter: Nothing to Disclose

Anat Mandel, Abstract Co-Author: Nothing to Disclose

Yehuda Fridman MD, Abstract Co-Author: Nothing to Disclose

Larisa Goranda MD, Abstract Co-Author: Nothing to Disclose

Laurian Copel MD, Abstract Co-Author: Nothing to Disclose

Meir Raz, Abstract Co-Author: Nothing to Disclose

Gabriel Polak MD, Abstract Co-Author: Nothing to Disclose

Joshua Shemer, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Purpose: Present a CT and MRI preauthorization program based on the ACR appropriateness guidelines, designed to better utilize CT and MRI, improve the quality of care and imaging and decrease the costs of CT and MRI imaging.

Material and Methods: Maccabi Health Care Services is the second largest health care provider in Israel providing primary care to more then 1.6 million patients. Obligatory preauthorization of CT and MRI requests at a preauthorization center staffed with Board Certified Radiologists was instituted during 2002. The preauthorization model is presented and multiple parameters are evaluated from 2000 to 2003. These include: annual number and cost of CT and MRI examinations, number of CT / MRI performed per patient at Macabbi Healthcare services and in various geographic districts, number of CT and MRI imaging requests sent to the center over time. Deferral rates were evaluated over time by district, by referring physician specialty and by the type of the radiology subspecialty of the imaging exam.

Results: Before preauthorization was required the annual number of CT and MRI examinations was increasing. After preauthorization was instituted the number of CT and MRI examinations per patient decreased from 0.0151 and 0.0021 in the year 2000 to 0.0084 and 0.0020 in 2003. The decrease in utilization of MRI and CT imaging between the years 2001 and 2003 was 8.7% (12,129 compared to 11,070 MRI examinations) and 32.5% (84,709 compared to 57,204 CT examinations) respectively. When comparing the CT and MRI imaging costs in 2001 and 2003 using 2001 examination prices (CT-$113, MRI-$500), the cost savings as a result of the implementation of the preauthorization process were 3.115 million US dollars for CT and 552,855 US dollars for MRI. There was a variable effect in the regional districts depending on cooperation with the preauthorization center. The deferral rate was 7.5% to 12.2 % (mean, 9.8%) for CT and 13.9% to 21.4% (mean, 17%) for MRI.

Conclusion: Preauthorization of CT and MRI requests by a center staffed with Radiologists, causes a significant decrease in utilization of these modalities, substantial cost savings and improved patient care.

Blachar, A, Tal, S, Mandel, A, Fridman, Y, Goranda, L, Copel , L, Raz, M, Polak, G, Shemer, J, et al, , Preauthorization of CT and MRI Examinations: Assessment of a Managed Care Program Based on the American College of Radiology Appropriateness Guidelines.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4411965.html