Reductions in High-End Imaging Utilization With Radiology Review and Consultation.
Following the uptake of value-based purchasing in concert with health care reform in the United States, providers, insurers, and patients are looking for ways to reduce excessive, dangerous, and/or inappropriate high-end imaging utilization (HEIU). Inappropriate HEIU is associated with patient safety risks due to unnecessary exposure to radiation, misappropriation of scarce equipment resources and staff, complications to clinical care, and needless, excessive costs for the patient, hospital, and payer. This paper presents a cost-effective radiology-initiated improvement program piloted in the Christiana Hospital Coordinated Care Network. The pilot demonstrated the effectiveness of regulating high-end imaging orders through radiologists' review of requests of the order as part of the consult process. Over the 2014-2015 fiscal year, 2,177 high-end imaging orders were reviewed by 26 radiologists for approval, rejection, or recommendation of an alternate examination. Of the orders, 86.7% (1887) were approved, 4.0% (87) were rejected, and 9.3% (203) received recommendation for an alternate examination. Based on improved patient safety, cost savings, and appropriate resource use, these findings suggest that radiologists' review can effectively reduce excessive HEIU. This method, with an appropriate algorithm to assist with handling a larger volume of orders, would be ideal to implement systemwide to manage HEIU cost efficiency, simultaneously providing radiologists with more control in their area of expertise and positively impacting quality, safety, and value-based purchasing goals.
Value Institute, Christiana Care Health System, Newark, Delaware. Electronic address: Bailey.C.Ingraham@ChristianaCare.org.
Bailey
B
Ingraham
Value Institute, Christiana Care Health System, Newark, Delaware.
Kristen
K
Miller
Department of Radiology, Christiana Care Health System, Newark, Delaware.
Alberto
A
Iaia
Department of Radiology, Christiana Care Health System, Newark, Delaware.
Michael B
MB
Sneider
Department of Radiology, Christiana Care Health System, Newark, Delaware.
Shabbir
S
Naqvi
Christiana Care Imaging Services and Department of Radiology, Christiana Care Health System, Newark, Delaware.
Kimberly
K
Evans
Department of Radiology, Christiana Care Health System, Newark, Delaware.
Vinay
V
Gheyi
Department of Radiology, Christiana Care Health System, Newark, Delaware.
Kert
K
Anzilotti
D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003691:Delaware / Q000453:epidemiology; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D015276:Health Care Rationing / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review
High-end imaging utilization; clinical decision support; radiologists review; radiology benefits management