Evaluation of a Program for Improving Advanced Imaging Interpretation.

Area of Science:

• Health Services Research
• Medical Quality Improvement
• Diagnostic Imaging

Background:

• Rapid growth in self-referred imaging raises concerns regarding healthcare costs and quality.
• A national payer developed a quality improvement program to ensure appropriate physician interpretation of diagnostic images.

Purpose of the Study:

• To evaluate the impact of an imaging interpretation criteria program on physician self-referral rates.
• To compare self-referral rates before and after program implementation.

Main Methods:

• The program allocated advanced imaging interpretation billing privileges based on physician specialty, with an appeal process for nonradiologists.
• Self-referral rates for computed tomography and magnetic resonance imaging were compared pre- and post-program using t tests.
• Analysis included stratification by physician appeal status and reimbursement restrictions.

Main Results:

• Physician self-referrals decreased significantly for those whose appeals were denied (17.4% to 8.2%) and those notified but not restricted (24.8% to 18.5%).
• Overall self-referrals in program states declined from 19.9% to 13.7% post-implementation.

Conclusions:

• The imaging interpretation criteria program led to a significant reduction in image interpretations billed by physicians outside their training scope.
• Implementation of such criteria can improve the quality of diagnostic imaging interpretation.