New tools from the ACR (American College of Radiology): appropriateness criteria and utilization analysis

Performing a clinically unnecessary study can cost a practice money under managed care and capitation contracts. The American College of Radiology (ACR) has developed two tools to help radiology facilities practice cost-efficient medicine without sacrificing quality of care: appropriateness criteria and utilization analysis. Appropriateness criteria were established by the ACR Board of Chancellors in 1993 to help imaging facilities determine appropriate imaging studies; these were first published in 1995; a subsequent edition will be published in 1996 and annually thereafter. Development of the criteria was based on Agency for Health Care Policy and Research guidelines. A task force which clinical conditions and variants were to be studied. The task force then performed a literature search. Members then reviewed the literature and reached a conclusion about the appropriateness of the various procedures. Because capitated contracts require some knowledge of the utilization of services, the ACR formed the utilization analysis committee in 1994. Facilities submit utilization data on a quarterly basis to the ACR. The data is then combined into both regional and national databases. These databases report back to the participating facilities, which can then compare themselves with other groups. All such information is confidential and is used for peer review only. A practice that participates in utilization analysis can view its own contract analysis, particularly in capitated contracts. Since many managed care organizations will not do business with a practice that hasn't performed this type of analysis, utilization analysis can be a way of winning contracts. Utilization analysis can also be a way to identify and control the risks that a practice has with managed care contracts. It offers the means for measuring a practice's performance against regional and national databases, and identifies areas of weakness. A practice is then able to take action to improve its quality of care in those areas.