If the check engine light comes on in your car, the mechanic diagnosing the issue is not going to start by checking the air pressure in your tires, right? While auto repair and healthcare are extremely different industries, the idea of unnecessary procedures and diagnostic tests wasting time and resources is the same. And it’s a problem that occurs in healthcare every day that is driving avoidable costs.
Campaigns such as Choosing Wisely® and the Appropriate Use of Medical Resources series have increased awareness of unjustified resource consumption and highlighted the value of integrating data analytics and benchmarking, evidence-based practice guidelines and performance improvement strategies to achieve value-based care delivery.
When CMS released the Overall Hospital Quality Star Rating on Hospital Compare it introduced an added layer of transparency to efficient, effective resource consumption. And they placed their initial focus on measuring the use of advanced diagnostic imaging (DI) in hospital outpatient settings, specifically for:
- Advanced DI for low back pain
- Use of cardiac imaging prior to low-risk non-cardiac surgery,
- Simultaneous brain and sinus imaging, and
- Use of computerized tomography (CT) for abdomen and thorax studies (with contrast).
To a casual consumer this area of focus may seem surprising; but to providers of emergency care and acute outpatient DI services this should be kind of a big deal. Here’s why:
- DI has experienced steep growth in volume over the past decade, particularly in the use of advanced imaging procedures which is fueling concerns about the amount of radiation exposure that patients experience.
- A study by Kocher, et al. (2011) found that almost one quarter of all CT use is through the Emergency Department (ED), and that CT use in the ED had increased 330 percent between 1996 and 2007.
- A survey published through the CDC (2012) found that for patients aged 65 and over, provision of advanced imaging during an ED visit increased from 11 percent in 2000 to nearly 29 percent by 2010.
Something has to change and CMS’ recent Hospital Compare makes it even more of a priority. If you are just starting this work, here are a few key considerations as you develop your roadmap for improvement:
- Analyze your advanced imaging utilization to assess for variations at the population and practitioner levels. This should include:
- Overall CT and MRI utilization in the emergency department (ED) and utilization in key high-prevalence populations
- Patient-level utilization demographics (i.e., age, gender, payer, etc.)
- Cost opportunity analysis to determine potential savings scenarios for both unjustified utilization and excess quantities-per-case.
- Discuss factors that influence advanced imaging utilization with your practitioners. A study by Griffey, et al., (2014) found that ED practitioners recognized advanced imaging to be a problem and believed that having knowledge about a patient’s cumulative exposure to radiation influenced their decision-making on what type of study to order.
- Identify clinical decision enablers that can support practitioners’ efficient and effective use of DI. Griffey’s study summarized that this included checking on things like “… the estimated radiation dose of the CTs they order; patients’ cumulative CT study counts; … and the appropriateness ranking of the imaging study being ordered, recommendations for alternate imaging options, and reminders and alerts for patients at increased risk from radiation.”
- Make and execute a plan that integrates industry guidelines for use of advanced imaging into clinical pathways; ongoing data analytics and timely reporting of utilization rates; and embedding oversight for your improvement efforts within your quality or service line committees.
Need help getting a jump-start on your plan? Register for our free webinar and learn more about a comprehensive measurement program that addresses 91 percent of the quality star measures.
I’m a healthcare improvement professional who designs, implements and provides leadership oversight for solutions that improve the quality, efficiency and cost of healthcare. I have a diverse blend of clinical, operational and analytical experience that spans pre-hospital, acute, chronic and long term care. When I’m not working, you’ll find me riding/racing bicycles through the woods or spending time with my son camping, snowboarding or nagging him to do chores. Connect with me on Twitter or LinkedIn.
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