Advanced diagnostic imaging (ADI) has become an important tool in managing patients’ health. It follows that purchasers expect their health plans and supporting partners to have standards in place to ensure high value and outcomes from ADI. This is especially true for self-funded health plans and government programs that sponsor and oversee the administration of insurance plans. A salient example is the ADI accreditation requirements established by the Medicare Improvement for Patients and Providers Act (MIPPA) of 2008, which RadSite’s MAP Accreditation Program is based on.
In 2019, RadSite teamed up with the National Alliance of Healthcare Purchaser Coalitions to better understand key trends associated with advanced diagnostic imaging that might impact clinical and financial outcomes. A joint workgroup was formed, made up of an array of industry and imaging experts, to study key areas that might impact quality.
After a dozen or so meetings, several key issues were identified, which became part of eValue8’s annual survey. In late 2020, the survey was sent out to health plans across the U.S. The questions address topics such as:
- Physics testing and imaging system calibration;
- The peer review process overseeing radiologists;
- Assessing conformance with “appropriate use” criteria (in part through utilization management); and
- Cone Beam CT imaging requirements and reimbursement.
To help frame these issues, the National Alliance recently published an issue brief, titled “Medical Imaging: Broadening the Focus To Include Cost and Value,” which addresses some of the policy issues associated with imaging trends. The publication highlights the importance of looking beyond cost-containment measures, which should include “value-based” metrics as well. One of the workgroup members is quoted in the brief: “Medical Imaging is essential for providing accurate diagnoses, addressing disease, and monitoring treatment. Purchasers and payers have a unique opportunity to establish quality measures that help ensure beneficiaries receive consistent quality, appropriate access, and cost-effective care in a safe environment…”
But the publication also notes that “medical imaging quality remains highly variable, with recent studies revealing alarming inconsistencies in imaging accuracy, interpretation, and resulting diagnoses and treatment recommendations.” Therefore, a primary goal of this initiative is to promote and standardize several performance indicators to ensure more consistent and effective ADI imaging.
Of course, RadSite is looking forward to helping achieve this goal through our own standards development efforts, including several new Center of Excellence (COE) programs under development.
The National Alliance, with RadSite’s assistance, will be releasing the results from the ADI survey later this year. In addition to a supplemental issue brief describing the findings, one or more webinars will be hosted on the topic. Stay tuned for additional details.
Garry Carneal, JD, MA
President & CEO