Orlando is where dreams come true. And in late February, dreams of better, more accurate patient care were coming alive at the Contemporary Resort located in the midst of Disney’s Magical Kingdom.

The Contemporary Resort played host to the 3rd Annual Maximizing Managed Radiology for Health Plans where ENT Drs. David Nielsen and Gavin Setzen shared the benefits of point-of-care imaging for better patient care with some of the top executives in the healthcare industry.

Who was in attendance?
Leading insurance companies from all around the country and national Radiology Benefit Managers (RBMs) came to the conference. RBMs are the folks you call when you need pre-authorizations for diagnostic imaging tests. They are the ones that say ‘no or ‘yes’ to a patient’s PET, MR, full-body or MiniCAT™ CT scan. They contract with many of the larger private payors to manage and ultimately reduce radiology utilizations. RBMs, like people, have different personalities. There are four nationally recognized RBMs, and of the four, a few choose to form effective working relationships with physicians and administrators, while the others tend to frustrate clinicians by placing barriers to diagnostics arguably at the expense of a patient’s well-being in order to meet its client’s financial goals.

It’s a matter of Perspective…
While denying diagnostic imaging to meet financial goals is wrong from the doctor’s perspective, it is equally wrong to allow physicians full diagnostic autonomy without appropriate checks and balances from the payor’s perspective. A decision based on a financial goal can come back to bite the corporate bottom line when disease is not prevented or detected in early stages. However a doctor left without guidelines can drive up unnecessary imaging costs and patient exposure to non-essential diagnostic testing. The answer lies in finding third-party independent oversight.

The direction is Accreditation
Over the years, the industry (payors, RBMs and physicians) tried various solutions. A payor required one thing, an RBM something completely different, while physician groups fought for physician-based referrals of patient diagnostic tests. There was rarely a consensus on how to make this work, and therefore no synchronization amongst payors on a national or even consistent basis. That is, until now. It has become clear over the past year and a half that the industry has naturally turned in one united direction: accreditation. And, for all practical purposes, it seems to be working. Sure there will still be a few bumps in the road and a few slow adaptors to the process, but there is outwardly a consensus. Bottom line, the national direction is accreditation for a clinic to stay competitive, provide better patient care and be eligible for diagnostic imaging reimbursements.

Presentation: Quality, accuracy, point-of-care CT
Dr. Nielsen, Executive Vice President and CEO of the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS), supports accreditation as it plays a key role in quality. He spoke of the efforts and progress made by the Ear, Nose and Throat specialty to engage member physicians and surgeons to ensure quality, accuracy and convenience for better patient care, based on the Institute of Medicine’s (IOM’s) six dimensions of quality.

Under the six dimensions, bringing diagnostic imaging directly to the patient, at the patient’s point-of-care, including the use of ultra low-dose volume CT scanners is clearly beneficial to patients. The ability to provide an immediate, early and accurate diagnosis is critical, but must be utilized only when clinically necessary. Appropriate point-of-care imaging can not only reduce delayed or inaccurate diagnoses, but could reduce inappropriate and costly prescriptions, additional office visits, and potentially even unnecessary procedures, while improving patient education and compliance. More studies and data are needed to evaluate whether or not increased point-of-care imaging can actually reduce rather than increase medical costs. Convenience and other benefits to the patient are noteworthy, and the technology that brings CT imaging to the patient also can reduce effective radiation dose, office visits, co-pays and workplace absenteeism.

Dr. Nielsen addressed questions of quality through compliance with nationally recognized accreditation societies, such as the Intersocietal Accreditation Commission (IAC). Dr. Nielsen emphasized, “We are committed to quality and clinically appropriate utilization of imaging. In the next three years we will promote quality standards, gather data on safety and outcomes, and work to improve physician education and utilization of necessary imaging.”

Presentation: Risks in delay, patient-centered care
With questions of quality and better patient care addressed, Dr. Setzen, Member of the Board of Governors of AAO-HNS and Board Member and Secretary of the Intersocietal Accreditation Commission of CT Laboratories (ICACTL), a division of IAC, took patient care one step further and presented the risks associated in delaying diagnostic imaging, and the benefits of providing an immediate accurate diagnosis – which ranged from staving off inappropriate medications, including antibiotics, to increasing patient compliance to reduction in overall healthcare costs. It became clear that when a physician is truly qualified, a physician should have access to diagnostic tools that will help patients at the time and place the patient needs help.

While insurance is always looking to save on costs, patients are always looking for improved patient care and doctors are searching for better tools. To ensure imaging tools are appropriately used, both Drs. Nielsen and Setzen support accreditation and quality initiatives focused on patient-centered care, and encourage health plans to share their data on utilization and standards and include physicians in the development of standards.

Presentation: Multi-specialty accreditation
Because of his background, Dr. Setzen was asked by the IAC to participate in the development of standards for their CT accreditation program. The standards developed are demanding and can stand up to the toughest critics. The IAC further carved out an accreditation program designed to accommodate volume CT scanners, and under this program, several of Xoran Technologies’ ultra low-dose point-of-care MiniCAT™ CT scanners are being accredited. IAC, like the American College of Radiology (ACR), is a nationally recognized accreditation organization. While the ACR is a membership organization for radiologists with an accreditation program designed by and for radiologists, the IAC is sponsored by all specialties involved in diagnostic imaging, with AAO-HNS being one of ten sponsoring organizations of the ICACTL. Most insurance companies in the industry today recognize the value of accreditation and support either IAC or ACR for reimbursement purposes.

Sandra Katanick, Chief Executive Officer for IAC, followed Drs. Nielsen and Setzen, providing an overview of the IAC’s multi-specialty standards across different imaging modalities. The IAC is comprised of five organizations, each ensuring high quality patient diagnostics and promoting health care within each specific medical specialty. Ms. Katanick fielded questions to an information-hungry audience, as demand for accreditation has grown dramatically over the past year.

The launch of a new era began this past February.