Radiology quality-improvement program could cut imaging spending by $433M if used across Medicare

A quality-improvement program could cut imaging spending by hundreds of millions of dollars, if used across the entire Medicare program, according to an analysis published Monday.

The Radiology Support, Communication and Alignment Network, or R-SCAN, operates by having referrers, rads and patients work together to bolster imaging appropriateness. Previous studies have proven the program’s efficacy and ability to deliver high-value radiology care, experts detailed in JACR.

Curious it might perform among Medicare recipients, researchers utilized R-SCAN data to determine the portion of low-value imaging and possible savings. Author Max Wintermark, MD, MBA, and colleagues unearthed eye-opening results, with $433 million in potentially reduced costs, if used across the federal payment program.

“Our analysis of the impact of R-SCAN on healthcare imaging costs shows the potential for substantial savings if the changes in imaging ordering observed in the previously published R-SCAN study are expanded globally for the Medicare population,” concluded Wintermark, with the Department of Radiology at Stanford University, and colleagues. “This will require ongoing education on evidence-based imaging, led by radiologists for their referring clinician colleagues and may be facilitated by the implementation of [clinical decision support] tools.”

For the analysis, researchers queried the American College of Radiology’s R-SCAN database, which contains info from practices participating in dozens of distinct projects. Using recommendations from both Choosing Wisely and the ACR, those involved have targeted low-value imaging such as CTA for pulmonary embolism, adnexal cyst imaging follow-up and advanced imaging for lower back pain. All told, Wintermark et al. included more than 4,700 R-SCAN cases in their analysis, submitted by 27 distinct radiology practices between 2016 and 2019.

The research team determined the proportion of appropriate and low-value studies performed among R-SCAN patients, along with percentage changes before and after the intervention. They then applied those results to a 5% sample of Medicare beneficiaries treated in 2017 and extrapolated the numbers across the entire population to reach that final number.

Based on the results, Wintermark and colleagues see a tremendous opportunity for physicians in imaging to step out of the reading room and lead the charge toward value-based care among seniors.

“The cornerstone of R-SCAN’s ability to reduce imaging overutilization lies in its ability to enhance collaboration and communication between radiologists and referring clinicians,” the team wrote. “In an era in which electronic imaging and PACS have reduced personal interactions between radiologists and referring clinicians, R-SCAN aims to restore and encourage the ongoing dialogue between these providers and to enhance the role of radiologists as stewards of appropriate imaging, sharing their knowledge of evidence-based imaging guidelines with their clinician colleagues, thus empowering them to implement these guidelines and improve the value of their care.”

You can read much more about their findings in the Journal of the American College of Radiology here. Other institutions contributing to the analysis included the ACR, its Harvey L. Neiman Health Policy Institute, NYU Langone Health, Emory University and the Georgia Institute of Technology.