Industry looks beyond reimbursement strategies for improving imaging services

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Physicians, health insurers and equipment manufacturers are increasing their efforts and initiatives to improve advanced medical imaging services offered to patients, according to a new report from Avalere Health.

“We’re seeing a new level of forward-leaning engagement by payors and physicians to get the right image for the right patient by the right doctor in the right setting of care,” said Jon Glaudemans, senior vice president of Avalere and co-author of the report.  “These new, more holistic approaches that extend beyond simple reimbursement strategies have the potential to improve the quality of advanced imaging care in tangible ways.”

According to the report, the authors focused primarily on updated and more comprehensive appropriateness guidelines; enhanced accreditation and certification programs; and expanded education and training – with a lens toward how these programs can influence provider behavior, imaging quality and patient care.

Some of the efforts profiled in the Avalere report seek to direct physicians to appropriate scans by providing new clinical guidelines at the point of care.  For example, United HealthCare and the American College of Cardiology Foundation (ACCF) have a new pilot program to test the appropriateness criteria for SPECT MPI in ten practice sites across the United States, at the point-of-service to assess the impact on ordering patterns.

Payors’ recent embrace and expansion of accreditation and certification programs reinforce efforts by physicians and imaging facilities to assure high-quality staffing, equipment and imaging protocols. Additionally, some payors are requiring that imaging facilities submit proof of accreditation as a condition for payment, the report said.

The educational front is an essential component in assuring appropriate use of advanced imaging technologies, according to the authors.  For example, Massachusetts General Hospital in Boston is deploying a decision support tool that allows doctors to access detailed appropriateness scores by providing patient symptoms and information at the point of care. This type of real-time education and feedback system has the potential to help physicians align their ordering patterns with the best available evidence, the report said.

According to Avalere, legislators have already expressed interest in applying imaging appropriateness criteria and accreditation to the Medicare program. The inclusion of both appropriateness guidelines and accreditation in multiple bills suggests policymakers view these initiatives as potential tools to optimize Medicare beneficiaries’ use of imaging services, the authors wrote.

The Medical Imaging & Technology Alliance (MITA) provided funding for Avalere’s research, “Diagnostic Imaging: Spending Trends and the Increasing Use of Appropriateness Criteria and Accreditation.”