The learner will be able to: 1) Identify the primary drivers of imaging utilization. 2) Understand the impact of legislative policy aimed at curbing imaging utilization growth rates. 3) Demonstrate the utility of clinical decision support tools in reducing inappropriate medical imaging. 4) Compare and contrast the impact of radiology benefits managers vis a vis clinical decision support tools built upon the ACR appropriateness criteria in reducing imaging growth rates. 5) Review the purpose of the Medicare Imaging Demonstration project.
Increased imaging utilization rates have contributed significantly to the growth of health care expenditures in the United States, particularly over the last decade. In response, a series of legislative policies have been enacted to curb the growth of imaging but thus far none have focused specifically on reducing the inappropriate use of advanced imaging modalities, a major contributor to rising imaging costs.
To date two major approaches have been employed to reduce inappropriate imaging utilization rates: 1) Incorporation of clinical decision support (CDS) tools into computerized physician order entry systems and 2) Use of external authorization bodies such as radiology benefit managers (RBMs). While both approaches have been shown to reduce imaging utilization rates, clinical decision support tools are more transparent in their approach and have been shown to specifically address inappropriate use of advanced imaging modalities.
Due to the lobbying efforts of the American College of Radiology and the growing body of literature demonstrating the effectiveness of CDS tools in reducing inappropriate imaging, language was included in the Medicare Improvements for Patient and Providers Act of 2008 (MIPPA) which mandated an appropriate use of imaging services demonstration project.
The Medicare Imaging Demonstration project (MID) has been deployed at 5 institutions across the US to assess the impact that decision support systems have on the appropriateness and utilization of advanced imaging services ordered for the Medicare fee-for-service population.
It is incumbent upon radiologists to be aware of current efforts at decreasing inappropriate imaging utilization so as to drive this progress moving forward.
Halabi, S,
Clinical Decision Support and CMS. Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL.
http://archive.rsna.org/2012/12020234.html
