Compliance and Quality Improvement Programs for Advanced Imaging
CareSelect Imaging expands on NDSC’s foundational ACR Select™ solution to deliver a comprehensive range of Appropriate Use Criteria (AUC) for diagnostic imaging in both adult and pediatric patient populations.
AUC is sourced from a growing list of medical specialty societies including multiple qualified Provider-Led Entities (qPLE) to ensure compliance with the Protecting Access to Medicare Act of 2014 (PAMA). qPLEs include the American College of Radiology, the American College of Cardiology, the National Comprehensive Cancer Network® and the Society of Nuclear Medicine and Molecular Imaging with additional Pediatric-Specific AUC authored through a collaboration between the American College of Radiology and the Society for Pediatric Radiology.
Advanced EMR integration
CareSelect integrates directly into caregivers EMR workflows, to enable the delivery of appropriate use criteria and care pathways that cover a wide variety of clinical topics, service lines and care settings. CareSelect exchanges real-time data with the EMR, performs applicable calculations, and provides evidence-based clinical guidelines and resources at the point of order placement. This decision support consultation enables healthcare providers access to the most appropriate test option or clinical pathway without changing their current workflow.
CareSelect has been adopted by 380+ health systems, 2700+ acute care facilities nationwide. NDSC currently processes over 5 million decision support consultations per month. Through thoughtful design and close cooperation with the EMR vendor community, the platform has been designed to streamline and improve the EMR experience without taking the user out of their native EMR application. NDSC integrates CareSelect exclusively into Certified EHR applications (CEHRT).
PAMA Compliant Decision Support
The Protecting Access to Medicare Act (PAMA) requires physicians to consult a Clinical Decision Support Mechanism (CDSM) for every Medicare Part B FFS advanced imaging (CT, MR, NM. PET) order. For each consultation, the CDSM must record a unique Decision Support Number (DSN). This unique identifier connects the NPI, selected indication and service, and the applicability of AUC to that order. The PAMA program starts with a voluntary reporting period from July 2018—December 2019. Formal requirements for consultation and data submission will begin in January 2020 with a one-year “Educational and Testing” period.
CareSelect Imaging enables full compliance with PAMA and conforms to all requirements from CMS for a qualified CDSM. With a comprehensive set of clinical content, including ACR Select™, CareSelect Imaging provides complete coverage of all advanced imaging to ensure AUC are available for consultation on every imaging order. This not only safeguards physicians, but guarantees all Priority Clinical Areas (PCAs) are covered by applicable AUC.
Imaging decision support guides healthcare providers to the most appropriate imaging test for a patient’s condition. Caregivers receive real-time feedback as to the appropriateness of their ordered test. In situations where a more appropriate test is recommended, the system enables the provider to revise their order, directly within the order entry workflow. A full suite of reporting tools enables sites to benchmark ordering patterns and identify and address gaps in care through CareSelect Imaging.
This approach ensures that only the most appropriate tests are ordered and enables stewardship over valuable and expensive imaging resources. This is particularly important for healthcare providers who operate in shared savings programs or paid under fixed payment models such as Medicare Part A, unnecessary tests use valuable and expensive resources with no benefit to patient outcomes.
The guidelines delivered by NDSC enable healthcare providers to directly impact imaging related quality measures such as defined by MACRA (e.g. CT over use) and the Outpatient Imaging Efficiency score, part of the CMS Hospital Compare Program. Ensuring tests conform to the nationally recognized guidelines delivered by CareSelect Imaging also reduces the risk of denials, as most payment programs generally align with these guidelines.
Point of care decision support is becoming a critical requirement across every value based payment model.
Benchmark to Power Imaging Stewardship and Quality Improvement
CareSelect Imaging serves as the platform to drive your organization’s quality improvement initiatives. Coupled with NDSC’s benchmarking and reporting tools, organizations can benchmark and reduce variations in care, and help drive more appropriate imaging. CareSelect Imaging enables organizations to meet quality improvement incentives linked to participation in MACRA, and other value based payment incentives.
CareSelect Imaging reporting includes four baseline reports designed to benchmark critical success metrics for the implementation of decision support. The easy to use reports track critical metrics including order appropriateness, decision support detail, impact and red-rate. Organizations can use CareSelect Imaging reporting to answer vital questions, such as which providers are ordering inappropriate studies frequently, which users are following the clinical decision support (CDS) recommendations, and how many orders are changed because of decision support feedback.
Automate Prior Authorizations
Managing the imaging prior authorization process can be cumbersome, consuming time and resources of both healthcare providers and patients. NDSC’s expertise in EMR data extraction, coupled with our ability to deliver payor specific guidelines, offers provider organizations the opportunity to automate many aspects of this process. In some cases, the current process can be completely replaced across all payers.
Comprehensive Clinical Content
American College of Radiology | ACR Select™
ACR Select is a comprehensive, national standard based, clinical decision support database comprising over 3,000 clinical scenarios and 15,000 criteria. The platform provides evidence-based decision support for the appropriate utilization of all medical imaging procedures. More than 300 volunteer physicians, representing over 20 radiology and non-radiology specialty organizations, participate on the ACR AC expert panels to continuously update these nationally transparent guidelines, and provide real-time access to the latest medical imaging decision support.
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American College of Cardiology
Appropriate use criteria from the American College of Cardiology (ACC) offers the addition of over 250 clinical indications and 2000 clinical outcomes to provide widespread coverage of cardiac advanced imaging procedures. Criteria is authored by the ACC Appropriate Use Criteria Task Force who oversee the creation of topic specific indications. Topics are selected by the AUC Task Force after careful review of the current variation in utilization, stakeholder needs, procedure volume and cost, available evidence, and feasibility. Input is uniformly sought from ACCF councils and committees, cardiovascular and imaging specialty societies, non-cardiologists, and relevant stakeholders such as health payers, policymakers, and patients. The AUC are aimed at guiding both diagnostic and therapeutic procedures based upon specific, commonly encountered clinical scenarios. ACC AUC are both evidence-based and utilize expert consensus.
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National Comprehensive Cancer Network
NCCN Imaging AUC™ include recommendations pertaining to cancer screening, diagnosis, staging, treatment response assessment, follow-up, and surveillance. Additional information includes the indication, imaging modality, and frequency of use, as well as clinical notes related to the specific recommendation. NCCN Imaging AUC also document information on disease stage and histology. All imaging procedures recommended in the NCCN Guidelines®, including radiographs, computed tomography (CT) scans, magnetic resonance imaging (MRI), functional nuclear medicine imaging (PET, SPECT) and ultrasound, are included within NCCN Imaging AUC. NCCN develops imaging appropriate use criteria based upon each multidisciplinary Guidelines Panel’s evaluation of available scientific evidence, including published literature and the expert judgment of the panel members. The widely accepted NCCN Categories of Evidence and Consensus score individual NCCN Imaging AUC™.
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Society of Nuclear Medicine and Molecular Imaging
SNMMI follows a balanced multidisciplinary approach to guidance development. The SNMMI Guidance Oversight Committee has identified several high priority areas for AUC development ranging from Bone Scintigraphy for Prostate and Breast Cancer to Thyroid Imaging. CareSelect Imaging includes the growing list of SNMMI approved AUC.
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Society for Pediatric Radiology
SPR Imaging criteria has been developed by leading pediatric experts through the American College of Radiology’s Rapid Response Committee process with the support of the Society for Pediatric Radiology. These collaboratively developed guidelines add 374 indications and 376 exams that cover 2912 clinical end points for pediatrics and are delivered by NDSC as part of CareSelect Imaging. SPR AUC also considers radiation exposure, an important factor in pediatric imaging and allows for age filtering to display only the most pertinent content base on patients age and gender.