"My Aching Back!"

Referring clinicians and radiologists come together to incorporate the low back pain guidelines into their patients' care.my aching back

When a patient comes into a clinic for lumbar spine pain, do referring physicians know exactly what to do? Should they order an imaging exam? Which imaging modality should be used to get the best result?

Many practices are using the Radiology Support, Communication, and Alignment Network (R-SCAN®) to address important patient care and health care cost issues regarding the use of imaging in the treatment of low back pain as well as for other topics.

R-SCAN is a free collaborative action plan that brings radiologists and referring clinicians together to improve imaging appropriateness based on a list of Choosing Wisely® topics. R-SCAN delivers immediate access to web-based tools and clinical decision support technology to help physicians optimize imaging care, reduce unnecessary imaging, and lower the cost of care. Referring clinicians and radiologists can fulfil their improvement activity requirements under the Merit-Based Incentive Payment System by completing a project (see bit.ly/RSCAN_IA).

In September 2015, the ACR received a CMS grant under the Transforming Clinical Practice Initiative (TCPI). One of the program’s aims is to sustain efficient care delivery by reducing unnecessary testing and procedures. CMS hopes this will generate 1–4 billion dollars in savings to the government and consumers. By using R-SCAN to carry out a project to reduce imaging for low back pain (a key TCPI quality improvement measure), Baylor College of Medicine in Houston demonstrated the type of improvement envisioned by the CMS leadership overseeing the TCPI.

Brian C. Reed, MD, head of outpatient clinics and community medicine at the Harris Health System and vice chair of community health programs at Baylor, was instrumental in creating collaboration between physicians at three clinics and radiologists at Baylor. Critical to the project’s success, Reed secured full cooperation from his clinics’ referring physicians.

Project leads Christie M. Malayil Lincoln, MD, assistant professor of radiology and neuroradiology at Baylor, and Melissa Chen, MD, then neuroradiology fellow at Baylor and now assistant professor at MD Anderson Cancer Center in Houston, set out to see if local clinics could improve the appropriateness of MR imaging for low back pain. Chen, Lincoln, and two radiology residents from Baylor participated in onsite provider education on the most appropriate time to image patients for low back pain. “They welcomed our expertise, especially in the era of rising health care costs,” says Lincoln of the response from the clinicians she trained.

Chen agrees that the practitioners were extremely receptive to the training, and many came with additional questions about ordering studies and getting in touch with radiologists. Providers expressed an interest in using R-SCAN with other topics and on a widespread level, including in private practices, says Chen. From Lincoln’s perspective, referring clinicians were “bridging a line of communication and understanding of each other’s needs for providing the best care to our community.”

“The combination of R-SCAN and ACR Appropriateness Criteria® led to a win-win situation for eliminating unnecessary MRI for low back pain,” says Reed. Additionally, Reed reports that primary care physicians were unhappy about the lengthy wait for a patient to receive an MRI appointment. Reed says, “Our patients were concerned about the delays for services, and all parties were experiencing some degree of frustration.” As a result of this initiative, those patients who needed an MRI had a shorter wait time.

Radiology practices throughout the country are engaging referring clinicians on the topic of low back pain, from a small private radiology practice in Delaware working with emergency physician colleagues at a regional medical center to an Asheville, N.C., radiology group working with several small primary care rural practices. The widespread use of R-SCAN is reducing patient waiting times for tests, reducing costs, and allowing radiologists and referring physicians to move into the era of value-driven care, even when it comes to your aching back.

By Dara L. Fox, editorial assistant, ACR Bulletin

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