OCM announces findings from Diagnostic Management Program

One Call Medical (OCM), the nation's leading provider of diagnostic testing (including MRI and CT scans) and specialty services (e.g. transportation and translation), today announced findings from its Diagnostic Management Program, revealing that on average, a typical workers' compensation payer may have as much as two-thirds of its diagnostic radiology referrals go "unmanaged," leading to overpayments, inefficiencies, and quality issues in the diagnostic referral, scheduling, and results process.

“With diagnostic radiology costs escalating, payers must 'manage' all aspects of the referral process”

In general, diagnostic radiology referrals are considered "unmanaged," if they are not routed through a diagnostic specialty network, like One Call Medical, which is designed to optimize advanced radiology savings, referral efficiency, and the quality of providers. Not only do unmanaged referrals result in higher diagnostic costs, but they also drive up administrative, medical, and indemnity expenses. For example, unmanaged referrals take more time for adjusters and nurse case managers to coordinate, and they may lead to inconclusive test results, which delay patient treatment, recovery, and return to work.

"With diagnostic radiology costs escalating, payers must 'manage' all aspects of the referral process," said Don Duford, president and COO at One Call Medical. "Most payers don't realize these problems exist. Since they route tests through traditional PPOs, they assume referrals are being adequately managed. However, since these networks don't specialize in diagnostic radiology, they only offer nominal discounts; they don't credential providers, and they don't actively manage the diagnostic referral, claims, or billing process."

Overpayments, waste, and inefficiencies are commonly referred to as "leakage" in the workers' compensation claims process. Pamela Landefeld, vice president of planning and strategy and radiology product manager at OCM, has noted a new and startling trend: "Unmanaged diagnostic referrals now represent a significant leakage problem that leads to millions of dollars in unnecessary costs. To address this problem, we've developed the Diagnostic Management Program as a systematic and holistic approach to ensure payers channel a greater number of scans to quality providers with optimal savings."

As the "smart" diagnostic specialty network, One Call Medical designed its Diagnostic Management Program (DMP) to help payers reduce leakage and capture the greatest value from their tests. One Call Medical's DMP saves payers up to 45 percent on advanced radiology services, nationally on average. OCM also manages and streamlines the entire referral process and facilitates accurate billing. In addition, all tests are performed and read by highly qualified OCM providers, who deliver accurate diagnostic information. Whereas industry studies claim that a significant portion of tests provide inconclusive data, OCM has less than a one percent complaint rate on the scans scheduled in its network.

The DMP is comprised of three key components:

• Proprietary Analytics. DMP analytics help payers understand the number of tests performed, total diagnostic spending, and the breakdown between "unmanaged" and "managed" referral activity. OCM works closely with payers to identify problem areas where leakage commonly occurs to improve referral patterns.
• Retrospective Savings. To address missed opportunities, OCM offers a Retrospective Savings Program, which identifies the 10 to 15 percent of diagnostic tests that may still qualify for network discounts. OCM re-prices those imaging services and bills the payer at the appropriate rate, resulting in a substantial and immediate savings for payers.
• Leakage-Capture Strategies. OCM partners with clients to implement leakage-capture strategies. For example, OCM offers geo-mapping tools to help locate network providers. Initial and recurrent training helps targeted audiences better understand the diagnostic radiology landscape, areas where leakage commonly occurs, and how it can be curbed. Ease-of-use tools enable claims professionals to expedite and offload administrative tasks, and workflow enhancements help payers to identify additional opportunities for savings.

Many DMP clients experience a dramatic shift from "unmanaged" referral activity and essentially double their rate of "managed" activity. This shift and doubling effect enables clients to reduce their total universe of diagnostic radiology spending by 20 percent, and to increase medical savings through improved outcomes. Overall, OCM has saved clients more than $150 million a year. In addition, injured employees benefit from accurate diagnostic information, which enables quality care, prompt recovery, and early return-to-work results.