From the July 2015 issue of HealthCare Business News magazine
HCBN: Tell us more about that aspect of protocol management. Does it help organizations meet federal mandates or reporting requirements?
SB: Mandates are really driving a lot of the move to these systems. Hospitals know they’ll need radiology clinical decision support tools in place by January of 2017 or they won’t get reimbursed for imaging studies. Medicare will require health care providers to consult appropriateness criteria developed by medical specialists when they order many kinds of radiology studies.
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These criteria typically assign an appropriateness score to indicate the likelihood that a specific imaging study will be useful to evaluate a patient with specific clinical symptoms. It is widely assumed that imaging exams that score higher in appropriateness are more likely to be reimbursed and vice versa. Systems need to provide the user with the relevant appropriateness criteria and a score when they place a radiology order. When you do that you’re going to ensure that your patient gets the right imaging study and that you get the highest reimbursement. Analytics will alert you if some members of your health care team are ordering inappropriate, unnecessary, or unreimbursed imaging studies.
One very important protocol management system benefit is that it can improve patient outcomes and satisfaction rates. It can also reduce the frequency of orders for unnecessary imaging scans. Some studies suggest that up to 30 percent of radiology exams are unnecessary or duplicative, and health care reform is really going after that unnecessary care.
HCBN: Are there any studies that have shown any improvement of practice patterns after installing a system like this? It’s intuitive that it would be the case, but one wonders if this has been looked at scientifically.
SB: We don’t have any numbers yet, but we’re launching a pilot study to learn more across four to eight facilities, and we’ll measure the impact we have on these facilities in terms of process efficiency, adherence to imaging protocols, compliance with appropriateness criteria, reimbursement rates, and clinical performance metrics.
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