Imaging Appropriate Use Criteria

WHY: Beginning in January 2020, the Centers for Medicare and Medicaid Services (CMS) will require documentation of Appropriate Use Criteria (AUC) for outpatient and ED orders for advanced imaging studies, which includes CT, MRI, PET and Nuclear Medicine scans. After the 2020 grace period, CMS will not pay for these studies if AUC documentation is not provided with the bill.

While the requirement for documenting AUC is a government mandate, it is important to note that the appropriate use of imaging is already a major goal of the McLaren High Value Care Program. Similar to blood and lab test utilization, the use of advanced imaging is highly variable among providers managing similar patients and the estimated rate of overuse is 20- 50%. Also of concern is that incidental findings (‘incidentalomas’) occur in 22- 38% of advanced imaging studies, which can lead to downstream testing, costs and patient anxiety. Most pertinent to our role as providers is that unnecessary imaging can lead to patient harm through radiation exposure, as CTs deliver radiation dosing that can be hundreds of times greater than plain films.

WHAT: Implement a systems-based project to require documentation of AUC for outpatient and ED advanced imaging studies. Project goals are to support evidence based imaging and to improve imaging stewardship.

HOW:

Multimodal approach to include three components:

• Education (HVC web site info, posters, pocket cards)
• Audit and feedback (HVC teams, attending physicians, radiologists)
• Clinical decision support using the CareSelect® platform
  • Offers point of order guidance in One McLaren Cerner to providers by integrating expert education from the ACR on overutilized and high value imaging exams
  • There will also be CareSelect® portal for non-Cerner EHRs.