CHICAGO—By bypassing prior authorization in favor of American College of Radiology (ACR) decision support criteria for ordering CT, MRI and other scans, the state of Minnesota saved $28 million in healthcare costs and halted the growth of imaging among 2,300 providers, according to a study presented Nov. 28 at the 96th annual scientific meeting of the Radiological Society of North America (RSNA).
Unyielding double-digit growth in CT, MRI, PET and nuclear cardiology exam volumes over the last decade have led many payors to require radiology departments to receive prior authorization from radiology benefits management (RBM) firms before performing the studies.
The Minnesota non-profit Institute for Clinical Systems Improvement (ICSI) worked with radiologists, providers and health plan representatives as part of a yearlong pilot study to discontinue prior authorization requirements and instead use ACR appropriate use criteria for CT, MRI, PET and nuclear cardiology exams. Five medical groups with a total of 2,300 providers were included in the study.
The trend in imaging growth for the covered providers halted entirely, with exam volume holding steady between 2006 and 2007; whereas in 2006 exam volume had grown 8 percent. The appropriateness of the exams ordered also increased by 10 percent using the ACR decision support tool.
Overall, decision support in lieu of prior authorization saved the five medical groups in the study a total of $28 million, according to lead researcher Cally A. Vinz, RN. Vinz projected substantially greater savings with ICSI's plan to offer the decision support tool to all Minnesota health care providers.
Vinz also touted the reduction in radiation associated with the one million fewer-than-projected exams resulting from the program. Additionally, the program cut approval time from an average of 10 minutes for prior authorization with RBM to 10 seconds using the ACR criteria, which resulted in improved clinician and patient satisfaction, Vinz reported.
The decision support tool extracted necessary patient information from patients' electronic health records (EHRs) and from a secured website. Vinz said ICSI will incorporate a data analysis component in the future program to track its effects on patient outcomes.
"Our study shows that decision support at the point of care is possible, can appropriately decrease utilization and providers love it," concluded Vinz. "Decision-support works."