Utilization management in radiology, part 1: Rationale, history, and current status

Journal of the American College of Radiology

Volumn 9, Issue 10, 2012, Pages 694-699

  Duszak, Richard ^a,b   Berlin, Jonathan W ^c  

^a Mid South Imaging and Therapeutics   (United States)

^b UNIVERSITY OF TENNESSEE HEALTH SCIENCE CENTER   (United States)

^c NORTHSHORE UNIVERSITY HEALTHSYSTEM   (United States)

Author keywords

benefits management; computerized physician order entry; decision support; radiology benefits management companies; Utilization management

Indexed keywords

COMPUTERIZED PROVIDER ORDER ENTRY; DECISION SUPPORT SYSTEM; DIAGNOSTIC IMAGING; HEALTH CARE COST; HEALTH CARE INDUSTRY; HEALTH CARE UTILIZATION; HEALTH INSURANCE; MARKETING; RADIOLOGY; REVIEW; UNITED STATES;

EID: 84926231628     PISSN: 15461440     EISSN: 1558349X     Source Type: Journal    
DOI: 10.1016/j.jacr.2012.06.010     Document Type: Article

References (39)

1. Congressional Budget Office The long-term outlook for healthcare spending http://www.cbo.gov/ftpdocs/87xx/doc8758/maintext.3.1.shtml Accessed October 19, 2011
2. J.K. Iglehart Health insurers and medical-imaging policy - a work in progress N Engl J Med 360 2009 1030 1037
3. D.C. Levin, V.M. Rao, L. Parker Physician orders contribute to high-tech imaging slowdown Health Aff (Millwood) 29 2010 189 195
4. E. Silva III I can't absorb anymore J Am Coll Radiol 8 2011 458 459
5. E. Silva III The search for misvalued services: why is radiology a target? J Am Coll Radiol 9 2012 7 8
6. B. Allen Jr, W.D. Donovan, G. McGinty Professional component payment reductions for diagnostic imaging examinations when more than one service is rendered by the same provider in the same session: an analysis of relevant payment policy J Am Coll Radiol 8 2011 610 616
7. D.C. Levin, V.M. Rao, L. Parker Trends in the utilization of outpatient advanced imaging after the deficit reduction act J Am Coll Radiol 9 2012 27 32
8. D. Armstrong Medicare moves to cut "self referral" practice The Wall Street Journal http://online.wsj.com/article/SB118955155529824347.html Accessed February 11, 2012
9. E.M. Crimmins, S.H. Preston, B. Cohen Explaining divergent levels of longevity in high-income countries 2011 National Academies Press Washington, DC
10. Y. Song, J. Skinner, J. Bynum, J. Sutherland, J.E. Wennberg, E.S. Fisher Regional variations in diagnostic practices N Engl J Med 363 2010 45 53
11. B.E. Sirovich, S. Woloshin, L.M. Schwartz Too little? Too much? Primary care physicians' views on US healthcare: a brief report Arch Intern Med 171 2011 1582 1585
12. M.S. Kale, T.F. Bishop, A.D. Federman, S. Keyhani "Top 5" lists top $5 billion Arch Intern Med 171 2011 1856 1858
13. A. Qaseem, P. Alguire, P. Dallas Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care Ann Intern Med 156 2012 147 149
14. M. Bernardy, C.G. Ullrich, J.V. Rawson Strategies for managing imaging utilization J Am Coll Radiol 6 2009 844 850
15. A.M. Kelly, P. Cronin Rationing and healthcare reform: not a question of if, but when J Am Coll Radiol 8 2011 830 837
16. B. Allen, D.C. Levin, M. Brant-Zawadzki, F.J. Lexa, R. Duszak ACR white paper: strategies for radiologists in the era of healthcare reform and accountable care organizations: a report from the ACR Future Trends Committee J Am Coll Radiol 8 2011 309 317
17. B.J. Hillman, C.A. Joseph, M.R. Mabry, J.H. Sunshine, S.D. Kennedy, M. Noether Frequency and costs of diagnostic imaging in office practice - a comparison of self-referring and radiologist-referring physicians N Engl J Med 323 1990 1604 1608
18. G.S. Gazelle, E.F. Halpern, H.S. Ryan, A.C. Tramontano Utilization of diagnostic medical imaging: comparison of radiologist referral versus same-specialty referral Radiology 245 2007 517 522
19. D.C. Levin, V.M. Rao Turf wars in radiology: updated evidence on the relationship between self-referral and the overutilization of imaging J Am Coll Radiol 5 2008 806 810
20. D.C. Levin, V.M. Rao The effect of self-referral on utilization of advanced diagnostic imaging AJR Am J Roentgenol 196 2011 848 852
21. D.C. Levin, R.L. Bree, V.M. Rao, J. Johnson A prior authorization program of a radiology benefits management company and how it has affected utilization of advanced diagnostic imaging J Am Coll Radiol 7 2010 33 38
22. J.M. Mitchell, R.R. Lagalia Controlling the escalating use of advanced imaging: the role of radiology benefit management programs Med Care Res Rev 66 2009 339 351
23. American Medical Association AMA survey of physicians on preauthorization requirements http://www.ama-assn.org/ama1/pub/upload/mm/399/preauthorization- survey-highlights.pdf Accessed October 20, 2011
24. American College of Radiology and the Radiology Business Management Association Best practices guidelines on radiology benefits management programs http://www.acr.org/SecondaryMainMenuCategories/GR-Econ/WhatsNew/ ACRRBMABestPracticesonRBMPs.aspx Accessed October 27, 2011
25. R. Duszak Deauthorization: the insidious new payer trick J Am Coll Radiol 3 2006 713 715
26. D.W. Lee, J.V. Rawson, S.W. Wade Radiology benefit managers: cost saving or cost shifting? J Am Coll Radiol 8 2011 393 401
27. Medicare Payment Advisory Commission Report to the Congress: Medicare and the healthcare delivery system http://medpac.gov/documents/Jun11-EntireReport. pdf Accessed October 20, 2011
28. I.K. Ip, L.I. Schneider, R. Hanson Adoption and meaningful use of computerized physician order entry with an integrated clinical decision support system for radiology: ten-year analysis in an urban teaching hospital J Am Coll Radiol 9 2012 129 136
29. Centers for Medicare and Medicaid Services CMS announces selection of demonstration participants in Medicare imaging demonstration project http://www.cms.gov/apps/media/press/release.asp?Counter=3896&intNumPerPage= 10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt= 0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5& intPage=&showAll=&pYear=&year=&desc=&cboOrder=date Accessed February 8, 2012
30. C.L. Sistrom, P.A. Dang, J.B. Weilburg, K.J. Dreyer, D.I. Rosenthal, J.H. Thrall Effect of computerized order entry with integrated decision support on the growth of outpatient procedure volumes: seven-year time series analysis Radiology 251 2009 147 155
31. C.C. Blackmore, R.S. Mecklenburg, G.S. Kaplan Effectiveness of clinical decision support in controlling inappropriate imaging J Am Coll Radiol 8 2011 19 25
32. S. Bowen, K. Johnson, M.H. Reed, L. Zhang, L. Curry The effect of incorporating guidelines into a computerized order entry system for diagnostic imaging J Am Coll Radiol 8 2011 251 258
33. D.I. Rosenthal, J.B. Weilburg, T. Schultz, J.C. Miller, V. Nixon, K.J. Dreyer, J.H. Thrall Radiology order entry with decision support: initial clinical experience J Am Coll Radiol 3 2006 799 806
34. J.S. Ash, P.N. Gorman, V. Seshadri, W.R. Hersh Computerized physician order entry in U.S. hospitals: results of a 2002 survey J Am Med Inform Assoc 11 2004 95 99
35. Educational Symposia Home page http://www.edusymp.com Accessed July 21, 2012
36. The Moran Company Assessing the budgetary implications of alternative strategies to influence utilization of diagnostic imaging services http://rightscanrighttime.org/wp-content/uploads/2011/10/AMIC-Final-UM-Report- 101820114.pdf Accessed October 20, 2011
37. S. Subramanian, S. Hoover, B. Gilman, T.S. Field, R. Mutter, J.H. Gurwitz Computerized physician order entry with clinical decision support in long-term care facilities: costs and benefits to stakeholders J Am Geriatr Soc 55 2007 1451 1457
38. R. Kaushal, A.K. Jha, C. Franz Brigham and Women's Hospital CPOE Working Group Return on investment for a computerized physician order entry system J Am Med Inform Assoc 13 2006 261 266
39. H. Stürzlinger, C. Hiebinger, D. Pertl, P. Traurig Computerized physician order entry - effectiveness and efficiency of electronic medication ordering with decision support systems GMS Health Technol Assess 5 2009 Doc07