The value of imaging appropriateness criteria

As reported in this issue of FierceMedicalImaging, the House Ways and Means Committee and the Senate Finance Committee have released a draft version of a policy to replace the sustainable growth rate formula that contains language that would require ordering physicians to consult appropriateness criteria before ordering advanced imaging services.

This is good news on several levels.

First, it's demonstrably clear that having access to, and referring to imaging appropriateness guidelines can reduce unnecessary imaging. For example, a recent study in Sweden showed that education efforts--such as publicly presenting statistics on inappropriate imaging at urology meetings and reminding physicians about guidelines--resulted in reducing the percentage of unnecessary scans among patients with low-risk prostate cancer from 45 percent to three percent.

In addition, the language in the SGR replacement policy draft would require the secretary of Health and Human Services to identify methods (such as clinical decision support tools) through which physicians can access and consult appropriate use criteria. There have been a number of studies demonstrating how CDS can reduce duplicate or unnecessary imaging.

It also bears mentioning that while some efforts to reduce unnecessary imaging--such as with the implementation of clinical decision support--will certainly bear fruit, other efforts will have more uncertain outcomes. For example, any move to reduce unnecessary imaging by eliminating the in-office ancillary services exception to the Stark Law will meet resistance from a number of medical organization and associations and within Congress.

Yet, it's also reassuring that a move towards clinical decision support, as well as implementing policies that require physicians to consult appropriateness criteria, could make eliminating the self-referral loophole superfluous. The hope is that once providers start applying those appropriateness guidelines and use decision support, we could also see a reduction in self-referred imaging.

Finally, rather than simply slashing reimbursements for medical imaging, a focus on imaging appropriateness makes sense. Reducing or eliminating unnecessary or duplicate imaging helps save precious healthcare dollars and also serves to enhance patient care by ensuring patients get the right scan at the right time, or no scan at all if it's not necessary.

As American College of Radiology Chair Paul Ellenbogen puts it, "That's what modern imaging care is all about." -Mike (@FierceHealthIT)

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