ACR portal brings CDS to Minnesota providers

The Minnesota Radiological Society (MRS) has launched the ACR Select™ online portal, which enables Minnesota physicians to consult radiology clinical decision support (RCDS) in lieu of pre-authorization for imaging exams.

With the ACR Select portal, healthcare providers will have direct access to ACR Appropriateness Criteria when ordering imaging services. Consulting the CDS leads to preapproval and creates a decision-support number, which assists with interaction between the referring physician and the imaging service provider and verifies the consult.

MRS worked with the National Decision Support Company (NDSC) to implement the technical solution and obtain the ACR Select software. Access is free to registered Minnesota physicians with a valid national provider identifier.

The portal is an initiative of ACR and NDSC, made available as a service for clinicians who don’t have access to a solution integrated in their EMR. It was designed to satisfy the "free" mechanism component of the Protecting Access to Medicare Act legislation.

“For over 20 years, the American College of Radiology, with several hundred physician experts, from more than 20 radiology and non-radiology specialty organizations, has developed and updated ACR Appropriateness Criteria® based on strong literature evidence basis. This ACR Select portal improves care and can remove tremendous cost and overhead due to the cumbersome prior authorization process,” said William Thorwarth, MD, American College of Radiology chief executive officer, in a prepared statement.

In the land of lakes

MRS President Kevin Smith, MD, sees this as a significant upgrade over the back-and-forth often involved with seeking approval from a radiology benefits management (RBM) company.

“The way RBMs work, it’s basically someone who says ‘yes’ or ‘no’,” Smith said in an interview with, adding that the decision-maker is generally not a physician. “The nice thing about ACR Select is that it’s going to be the physician putting the order in, and they get feedback immediately.”

Smith thinks this new portal also will help referring physicians learn on the job and gain a better understanding of when exams are and aren’t necessary.

“You’re educating the physician on the front line,” Smith said. “[With the old method], the physician ultimately never knows. They sign the order, then a few hours later, the study is denied and it goes through another process. In the meantime, the patient is sitting there in the middle, not getting their test, and it’s not based on a physician’s decision.”

Minnesota has a decade-long history in the advancement of RCDS. As early as 2004, Minnesota healthcare companies began discussing the idea of moving away from third-party RBMs. A CDS pilot program operated in the state by the Institute for Clinical Systems Improvement (ICSI) was so successful that it remained in place years longer than originally planned.

The Minnesota ACR Select portal comes at a critical juncture in the development of RCDS. H.R. 4302, the Protecting Access to Medicare Act of 2014, included a mandate, beginning in January 2017, that physicians ordering outpatient advanced diagnostic imaging exams first consult government-approved CDS software before the imaging provider can receive full Medicare/Medicaid reimbursement.