Achieving Success With R-SCAN
ACR’s collaborative action plan helps physicians meet MACRA requirements.
The ACR Radiology Support, Communications and Alignment Network (R-SCAN®) empowers radiologists to take the first step in building a collaborative and consultative relationship with their referring clinicians. With its ready-to-go projects, R-SCAN is helping radiologists thrive in the CMS Quality Payment Program (QPP) established under MACRA.
According to Ashima Lall, MD, MBA, FACHE, system chief of performance improvement at the Radiology Associates of the Main Line in Media, Penn., conducting an R-SCAN project was a win-win opportunity for both her practice and Main Line Emergency Medicine Associates, LLC — both affiliated with the Main Line Health system. Lall engaged emergency medicine physician Rebecca L. Pasdon, DO, in an R-SCAN project to significantly improve the ordering of imaging exams for patients who present with symptoms of suspected pulmonary embolism (PE) at the ED. Together, they spearheaded the initiative to reduce dose, cost, and inconvenience for patients at Main Line Health’s Riddle Hospital in Media.
To kick off the project, Lall retrospectively reviewed cases ordered for suspected PE to determine if they aligned with the ACR Appropriateness Criteria® guidelines. She shared with Pasdon the results that showed an opportunity for improved exam ordering. They then embarked on an educational program to increase the appropriateness of imaging exams ordered for PE indications. The case review, after the educational intervention, demonstrated that their efforts resulted in a 45 percent improvement in the appropriateness rating of imaging exams ordered for suspected PE. The project earned both practices Improvement Activity (IA) credits for 2017 for the Merit-based Incentive Payment System (MIPS) track of the QPP.
“As an enhancement to the standard R-SCAN program, we engaged patients to learn about the appropriateness of the imaging for their particular situation,” says Lall. The team provided patients who needed imaging with educational materials about why they needed imaging. At a later time, a nurse contacted the patient and discovered that the information sharing was helpful. “It’s rewarding to hear that patients like to be informed about diagnostic testing,” says Lall. She emphasizes that the R-SCAN turnkey program — including the many educational materials — was instrumental in carrying out the collaboration, and the step-by-step process made it easy to present to and gain buy-in from Pasdon.
Brandon W. Skelton, MD, manager of Magnolia Imaging Associates in Corinth, Miss., achieved similar success with R-SCAN. Skelton and his colleagues noticed they were performing a fair number of follow-up ultrasounds for clinically inconsequential adnexal cysts. They decided to start an R-SCAN project to educate themselves and their referring providers while simultaneously improving the care provided to their patients by avoiding unnecessary repeat exams.
“R-SCAN helped us meet the demands of both maintenance of certification and CMS’ QPP,” says Skelton. And at the center of the process, he notes, was the motivation to avoid unnecessary cost and inconvenience for patients. “In our project, we saw a reduction in low/ medium weight exams by over 50 percent between baseline data and post education data.”
Skelton’s group has already begun focusing on a new project this year to look at the number of rib radiographs performed through the ED. “We started this project in an attempt to decrease the use of this particular exam in the ED setting,” says Skelton. “Anecdotally, it does seem the number of rib series ordered has diminished since the project was started.” By the end of 2018, Skelton’s group will have data to support those observations, and both the radiologists and partnering ED doctors will be able to earn IA credits.
Both Lall and Skelton believe R-SCAN demonstrates the impact radiologists can have on the management of patient care and the careful use of healthcare resources. The project framework makes for structured collaboration between radiologists and clinicians, while keeping the patient at the center of the conversation.
“We hope that other providers around the country take advantage of R-SCAN to improve care,” says Lall.
By Audrey Caldwell, freelance writer, ACR Press