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Avalere Examines Emerging Strategies for Managing Imaging Utilization

Contact: Lindsey Spindle, 202.207.1337, lspindle@avalerehealth.net

07.10.08

Washington, DC – Efforts and initiatives designed to improve the utilization of advanced medical imaging services are increasing, says a new report released today by Avalere Health.  The report comes at a time when healthcare leaders and policymakers are actively exploring how to help patients access advanced imaging services while assuring high-quality, cost-effective diagnosis and treatment. 

Avalere’s new report highlights approaches used by physicians, health insurers, and equipment manufacturers to help doctors offer their patients appropriate and efficient imaging services.  The report’s authors focused primarily on three sets of approaches – 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.

“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.” 

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 ACCF’s appropriateness criteria for SPECT-MPI, an advanced imaging technique.  The program’s new data-rich registry will track rates of appropriate, inappropriate, and uncertain scans while providing physicians with personalized feedback about their performance. 

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

Lastly, a push on the educational front is an essential component in assuring appropriate use of advanced imaging technologies.  Massachusetts General Hospital, profiled in the Avalere report, deploys a decision support tool that allows doctors to access detailed appropriateness scores by providing patient symptoms and information at the point of care.  While the ordering decision ultimately lies with the doctor, this type of real-time education and feedback system represents a potential new approach to help physicians align their ordering patterns with the best available evidence.

Legislators have already expressed interest in applying imaging appropriateness criteria and accreditation to the Medicare program. Both initiatives appeared in House-passed legislation, as well as draft bills from Senate leaders. While legislators have yet to finalize a Medicare package, 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 Medicare program could employ numerous tools to help optimize the appropriate use of diagnostic services,” said Glaudemans.  “Policymakers and the research community should carefully track these new efforts and see how they may fit into future Medicare policy.”

“Diagnostic Imaging: Spending Trends and the Increasing Use of Appropriateness Criteria and Accreditation” was authored by Cara Demmerle and Jon Glaudemans, both of Avalere Health.  The Medical Imaging & Technology Alliance provided funding for the research.  Avalere maintained editorial control and the conclusions expressed in the research paper are solely those of the authors.

Avalere Health is an advisory services company whose core purpose is to create innovative solutions to complex healthcare problems. Based in Washington DC, the firm delivers research, analysis, insight, and strategy for leaders in healthcare business and policy. Avalere's experts span 125 staff drawn from the federal government (e.g., CMS, OMB, CBO, and the Congress), Fortune 500 healthcare companies, top consultancies, and nonprofits. The firm offers deep substance in areas ranging from healthcare coverage and financing to the changing role of evidence in healthcare decision-making. Its focus on strategy is supported by a rigorous, in-house analytic research group that uses public and private data to generate quantitative insight. Through events, publications, and interactive programs, Avalere also translates real-time healthcare developments into actionable information.

Learn more at www.avalerehealth.net.

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