Cally Ann Vinz RN, Presenter: Nothing to Disclose

ICSI is in the process of offering this decision-support option to all medical groups and hospitals in Minnesota—the first time such a major initiative has been launched across a state. The Centers for Medicare and Medicaid services has been introduced to this option and plans to announce a $10 million demonstration project that likely will be consistent with elements of the ICSI option to prior notification.

The use of high-tech diagnostic imaging (HTDI) exams (CT, MRI, PET and nuclear cardiology) has been climbing dramatically at double-digit increases nationally in the last decade. The increases prompted many health plans to require prior notification processes, whereby providers must call a radiology benefits management (RBM) firm before ordering an exam. ICSI convened radiologists, providers and health plan representative to find a better way to ensure appropriate usage of HTDI.

ICSI conducted a yearlong pilot involving five medical groups where 2,300 providers used American College of Radiology criteria to order HTDI scans. By using this EHR approach, the pilot groups did not have to go through prior authorization. The diagnostic quality of scans ordered approach increased 10%. The pilot contributed to a 0% increase in HTDI claims filed in 2007 (vs. an 8% increase in 2006), reduced patient exposure to unnecessary radiation, increased provider efficiency, and saved an estimated $28 million in health care costs.

The pilot convinced ICSI to develop a decision-support solution to enable adopters to use a common set of appropriateness criteria for order HTDI scans either through their EHR or via a secure Web site at the point of order. ICSI, health plans and medical groups in Minnesota have licensed appropriateness criteria from a vendor. ICSI’s solution includes a data analysis tool to enable participating medical groups and ICSI (from de-identified, aggregate data) to correlate how provider ordering practices with the tool improve patient outcomes.

Vinz, C, Minnesota Spreads Statewide Decision Support Option for High Tech Imaging Orders: Real Time at the Point of Order.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9015793.html