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  • Suboptimal Utilization of Imaging Studies

  • Answer to Question 1

    As is true with all physicians, radiologists have a duty to ensure that only the appropriate and optimum level of care is provided to patients. Achieving this level of care is likely to require continual oversight and review by members of the radiology practice. Although the practice of medicine is associated with varying levels of diagnostic uncertainty, many clinical problems have been studied extensively, with generally accepted ways of arriving at the best diagnosis and treatment. Physicians who follow the tenets of evidence-based medicine will tend to be aware and conscientious about the need to ensure appropriate utilization of health care services, including the use of expensive imaging technology.

    In this vignette, you have already identified at least one physician whose test-ordering practice appears to lead to overutilization of imaging services, including expensive MR imaging studies. However, sudden confrontation of that referring physician about his or her test-ordering practice may be highly counterproductive, especially in the absence of evidence. Therefore, answer B is incorrect.

    Clinical decision support has been shown to reduce the frequency of inappropriate utilization of advanced imaging tests (1). While the introduction of a computerized physician order entry system may prove to be a wise investment over the long term and can be accepted clinically (2), it will represent a sizable short-term cost and may be associated with initial difficulties by the end users. The system also does not directly deal with the specific short-term issue of overutilization of imaging technology by a single provider. Therefore, answer E is incorrect.

    Upgrading the skills and knowledge of administrative staff about the intricacies and complexity of coding and billing may often be helpful to the welfare of the radiology practice. However, such upgrading likely would not address the specific issue of inappropriate utilization. Answer A is incorrect.

    On the other hand, warning the insurers about the possibility of legal action if they refuse payment for imaging studies deemed to be clinically appropriate is likely to go nowhere and could be counterproductive. Answer D is incorrect.

    Since you are aware of a set of imaging studies that are at risk for being deemed medically unnecessary and therefore not reimbursed, your practice is likely to benefit from discovering key pieces of information. This information includes the percentage of imaging studies that fall into this category, the identity of the referring physicians who request the majority of these studies, and the kinds of operational processes that allow these imaging studies to be scheduled without a high likelihood of reimbursement. In discussion with the referring clinician, you may be able to use published guidelines to arrive at a better evidence-based approach, including the appropriateness guidelines of the American College of Radiology (ACR) (3–6).

    The correct answer is C (review the previous month’s MR imaging orders, tally the potentially problematic cases, and arrange a discussion with the local physician about the upcoming changes and these potential “problem” cases). 



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Discounted Dues: Eligible North American Countries 
Belize
Costa Rica
Dominican Republic
El Salvador
Grenada
Guatamala
Haiti
Honduras
Jamaica
Netherlands Antilles
Nicaragua
Panama
St.Lucia
St. Vincent & Grenadines
Country    Country    Country 
Afghanistan   Grenada   Pakistan
Albania   Guatemala   Papua New Guinea
Algeria   Guinea   Paraguay
Angola   Guinea-Bissau   Peru
Armenia   Guyana   Phillippines
Azerbaijan   Haiti   Rwanda
Bangladesh   Honduras   Samoa
Belarus   India   Sao Tome & Principe
Belize   Indonesia   Senegal
Benin   Iran   Serbia
Bhutan   Iraq   Sierra Leone
Bolivia   Jordan   Solomon Islands
Bosnia & Herzegovina   Jamaica   Somalia
Botswana   Kenya   South Africa
Bulgaria   Kiribati   South Sudan
Burkina Faso   Korea, Dem Rep (North)   Sri Lanka
Burundi   Kosovo   St Lucia
Cambodia   Kyrgyzstan   St Vincent & Grenadines
Cameroon   Laos\Lao PDR   Sudan
Cape Verde   Lesotho   Swaziland
Central African Republic   Liberia   Syria
Chad   Macedonia   Tajikistan
China   Madagascar   Tanzania
Colombia   Malawi   Thailand
Comoros   Maldives   Timor-Leste
Congo, Dem. Rep.   Mali   Togo
Congo, Republic of   Marshall Islands   Tonga
Cote d'Ivoire   Mauritania   Tunisia
Djibouti   Micronesia, Fed. Sts.   Turkmenistan
Dominica   Moldova   Tuvalu
Domicican Republic   Mongolia   Uganda
Ecuador   Montenegro   Ukraine
Egypt   Morocco   Uzbekistan
El Salvador   Mozambique   Vanuatu
Eritrea   Myanmar   Vietnam
Ethiopia   Namibia   West Bank & Gaza
Fiji   Nepal   Yemen
Gambia, The   Nicaragua   Zambia
Georgia   Niger   Zimbabwe
Ghana   Nigeria    

Legacy Collection 2
Radiology Logo
RadioGraphics Logo 
Tier 1

  • Bed count: 1-400
  • Associate College: Community, Technical, Further Education (UK), Tribal College
  • Community Public Library (small scale): general reference public library, museum, non-profit administration office

Tier 2

  • Bed count: 401-750
  • Baccalaureate College or University: Bachelor's is the highest degree offered
  • Master's College or University: Master's is the highest degree offered
  • Special Focus Institution: theological seminaries, Bible colleges, engineering, technological, business, management, art, music, design, law

Tier 3

  • Bedcount: 751-1,000
  • Research University: high or very high research activity without affiliated medical school
  • Health Profession School: non-medical, but health focused

Tier 4

  • Bed count: 1,001 +
  • Medical School: research universities with medical school, including medical centers

Tier 5

  • Consortia: academic, medical libraries, affiliated hospitals, regional libraries and other networks
  • Corporate
  • Government Agency and Ministry
  • Hospital System
  • Private Practice
  • Research Institute: government and non-government health research
  • State or National Public Library
  • Professional Society: trade unions, industry trade association, lobbying organization