By leveraging the American College of Radiology’s (ACR’s) Radiology Support, Communication and Alignment Network (R-SCAN™) project, North Carolina clinicians are using Choosing Wisely to forge new partnerships, achieve quality goals for new Medicare reimbursement models and become familiar with imaging appropriate-use criteria (AUC). R-SCAN is a collaborative clinical improvement activity based on Choosing Wisely recommendations that ensures referring clinicians and radiologists provide patients with the most appropriate imaging exam.
During the last two years, Asheville Radiology Associates, located in Asheville, N.C., has been working closely with Mission Health, the health system it serves. Mission Health is composed of six hospitals and several ambulatory radiology locations spread across the region, including rural areas.
With guidance from a quality specialist, referring clinicians and radiology teams at Asheville Radiology learned about R-SCAN and signed up to participate through the R-SCAN website. This project was then presented to Mission Health’s Medical Directors Committee to obtain buy-in at all levels of the organization. Work is now ongoing to complete R-SCAN collaborations that satisfy Improvement Activity credit requirements under the Merit-based Incentive Payment System (MIPS).
Examples of early success include:
- Reducing low-value imaging exams;
- Reducing order cancellations and modifications that impact both providers and support staff;
- Reducing the time for exam preauthorization by ordering the right exam from the outset; and
- Educating referring clinicians over a wide geographical area about appropriate image ordering.
Asheville Radiology and Mission Health are also working to implement imaging clinical-decision support (CDS) that provides access to AUC at the time clinicians order an imaging exam in preparation for compliance with the Protecting Access to Medicare Act of 2014, which will require referring clinicians, beginning in 2019, to demonstrate they have consulted AUC when ordering advanced imaging procedures for Medicare patients.
R-SCAN provides Mission Health physicians an opportunity to try out CDS and use this technology in a novel way to help determine if they might be ordering low-value imaging tests. Collaborating teams reviewed R-SCAN data during one-on-one appointments and discussed strategies to ensure appropriate imaging. They are now looking to gather data to see if the collaboration has reduced low-value imaging orders.
Learn more about R-SCAN’s work to streamline implementing evidence-based Choosing Wisely recommendations:
- Case study: Homing In On Quality
- Case study: Quality’s Wider Scope
- Video: Preparing Stakeholders for Imaging Clinical Decision Support
- Clinicians can receive Maintenance of Certificate credit for R-SCAN projects
- Conversations to Optimize Imaging Care [pdf]