This post was authored by Bob Hendel, MD, FACC, chair of the Imaging in FOCUS work group.
Overuse has been a potential problem for some time with the fee-for-service model of care. As mentioned in last week’s history of Appropriate Use Criteria (AUC) post, more than a decade ago, usage statistics for diagnostic imaging showed imaging to have the fastest growth among all medical services covered by Medicare. Additionally, marked geographic variation in use patterns is present, further raising questions about the appropriateness of cardiac imaging in certain setting. This procedural growth has slowed in recent years, with a number of factors contributing to this decline.
In 2010, the ACC developed Imaging in FOCUS, a national quality improvement initiative designed to help cardiovascular professionals best use AUC and ultimately reduce inappropriate imaging. The FOCUS initiative is comprised of a voluntary community as well as a case review tool to provide appropriate use determinations for individual patients and allows physicians and other organizations to track AUC patterns and exceptions over time.
To date, Imaging in FOCUS is comprised of over 600 sites distributed throughout the country. Sites document their AUC patterns, goals, and action plans in a structured, three-part performance improvement module and utilize the FOCUS Community resources to help inform their work. The community is also working on best practices in implementing AUC. Many sites are imaging labs reviewing AUC patterns for quality improvement credit toward lab accreditation. ABIM maintenance of certification Part IV (quality improvement) credit is also available for participating physicians.
Since the FOCUS community’s start, the College has already documented significant improvements in appropriate use (as high as 50% reduction in inappropriate use). The College has also been working with ACC Chapters and insurance companies to widely adopt a new web-based tool powered by Medicalis as an alternative to third party radiology benefit managers that require prior authorization for procedures. This tool provides a way for physicians and their staff to implement AUC at the point of care (web portal or EHR integration). This approach is currently in use in Delaware. It is built upon ACC core competencies and offers a performance-based, transparent and accountable solution to reduce inappropriate testing, not just indiscriminant volume reduction. This same product will be offered directly to practices and hospitals later this year for direct use in patient care on an ongoing basis and contract negotiations with individual payers.
We’ve come a long way over the past few years but our work is not yet done as we still are working to educate health plans and members of Congress about the benefits of AUC, as well as what the College is doing to put AUC directly in the hands of providers and ensure appropriate testing. Through these efforts and other programs, the College wishes to promote optimal patient care and resource-sensitive procedural utilization.
For more information on how to engage health plans or other stakeholders around these issues as well as more about ACC’s Imaging in FOCUS initiative, visit www.CardioSource.org/FOCUS.