ICSI launches new initiative to save health care imaging costs, improve patient care

ICSI Option Can Help Ensure Right Procedures Are Ordered at Point of Care, Improving Patient Care and Slowing the Rise in Health Care Imaging Costs

A new initiative launched by the Institute for Clinical Systems Improvement (ICSI, www.icsi.org), a nonprofit, health care improvement organization, could save the Minnesota health care community more than $28 million annually, as well as improve patient care and provider groups' productivity.

The initiative is the first statewide diagnostic imaging decision-support approach in the country.  For participating medical groups and hospital-based clinics in Minnesota it offers a clinical "decision-support" tool, embedded in their electronic medical record (EMR) or accessible via the Web, so their providers can order appropriate high-tech diagnostic imaging (HTDI) exams while with the patient.

"Use of HTDI procedures such as MRI, CT, PET and nuclear cardiology tests has been increasing 8% annually in Minnesota, and more than $100 billion is spent each year on diagnostic imaging nationally. Yet there have not been enough studies to correlate this increase with improved patient outcomes," says Cally Vinz, vice president of clinical products and strategic initiatives, ICSI.  "Our goal with this initiative is to ensure the appropriate use of HTDI exams based on the medical evidence so that patients get better care, providers are more efficient and health care is more affordable."

Based on Yearlong Pilot and Subsequent Two-Year Usage

The ICSI initiative expands upon a pilot involving roughly 4,000 physicians from five Minnesota medical groups—Allina Medical Clinic, Fairview Health Services, HealthPartners Medical Group, Park Nicollet Health Services, and St. Mary's/Duluth Clinic Health System; four health plans—Blue Cross Blue Shield of Minnesota, HealthPartners, Medica, and UCare; and the Minnesota Department of Human Services (DHS).

The pilot was the result of an ICSI collaboration with provider groups, radiologists, health plans and DHS to explore options to prior notification processes for ordering high-tech exams. Put in place by several Minnesota health plans in 2007, prior notification helps ensure that appropriate HTDI exams are ordered. Most prior notification processes require the physician to call a radiology benefits management (RBM) firm to determine if an HTDI procedure is appropriate and covered by insurance prior to ordering it.

The ICSI pilot showed that using decision-support appropriateness criteria—based on American College of Radiology (ACR) and other specialty organizations' data—improved the diagnostic value of exams ordered, reduced patient exposure to unnecessary radiation, and contributed to a 0 percent increase in HTDI exams ordered in 2007 following an 8 percent increase in Minnesota in 2006. This resulted in an estimated $28 million in health care cost savings.

The five medical groups have continued to use the decision-support criteria since the pilot ended without having to call RBMs for prior notification approvals—these continue to be secured by using the appropriateness criteria in their EMRs.  The groups also report improved patient satisfaction, greater clinic efficiencies and reduced administrative costs. In total, it is estimated that by using this approach for the past three years, the five medical groups have helped save Minnesota $84 million, as there has not been an increase in the use of HTDI scans in Minnesota since 2007.

Based on more than 1 million scans ordered by the pilot medical groups, ICSI is offering this decision-support approach to all medical groups and hospital-based clinics in the state.  Medical groups with Epic EMR systems will have the earliest opportunity to adopt this solution, with the Web-based option available late in the first quarter of 2011.  

Decision-Support Tool

With this ICSI initiative, this proven approach is now being offered to medical groups and hospital-based clinics across Minnesota using a broad "common" set of appropriate criteria licensed from Burlington, MA-based Nuance Communications, Inc. Nuance's RadPort software contains appropriateness criteria based on national standards created by ACR and other specialty organizations.  

Using RadPort, the physician can select an exam based on the patient's illness or indications, run it against the criteria, and receive a score on the computer screen ranging from low- to high-diagnostic utility (1-9).  If the physician selects a low-utility exam, the system offers evidence-based superior alternatives. This not only helps ensure the best exam is ordered the first time, but the interactive tool serves as an educational resource to improve physician ordering practices over time.  It can also enhance patient-physician relationships through shared decision-making, and help patients avoid unnecessary radiation exposure and imaging costs.

Medical groups adopting the ICSI solution might also be able to forego calling an RBM if the participating health plan accepts the electronic-based decision-support tool as an automatic form of prior notification.

Improving Patient Outcomes

The ICSI solution also includes Nuance's data intelligence tool, RadCube, which can collate and analyze the appropriateness of exams ordered so that participating medical groups can trend ordering patterns and correlate them to patient outcomes. ICSI will have access to de-identified data of the medical groups using the RadCube data warehouse so it can help improve the Minnesota health care community's knowledge of which diagnostic imaging exams obtain the best patient outcomes based on their individual medical conditions. ICSI will also help educate adopters on how to implement and maintain this decision-support option.

Potential National Impact

The ICSI solution is being viewed as a potential model for how health information technology can have a meaningful positive impact on patient care while also reducing health care costs for consumers, patients, employers, providers and health plans. The Centers for Medicare and Medicaid Services (CMS) has considered the use of prior authorization to slow the burgeoning increase in the use of HTDI procedures in the national Medicare population. Following a review of the ICSI decision-support pilot, CMS in July 2010 announced it would conduct a demonstration project to determine if electronic decision-support can improve quality of care and reduce unnecessary radiation exposure and utilization by promoting appropriate ordering of advanced imaging services nationally.