Outpatient facility-based order variation in combined imaging

English version

Autoři: Adam C. Powell ^aff001; Yan Wang ^aff001; Gary L. Smith ^aff001; James W. Long ^aff002; Uday U. Deshmukh ^aff001; David P. Friedman ^aff001; Christopher G. Roth ^aff001; Baskaran Sundaram ^aff001
Působiště autorů: HealthHelp, Houston, TX, United States of America ^aff001; Humana Inc., Louisville, KY, United States of America ^aff002; Thomas Jefferson University, Philadelphia, PA, United States of America ^aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0224735

Souhrn

Objective

Combined computed tomography (CT) occurs when one anatomical area is simultaneously imaged both without and with contrast, or two overlapping anatomical areas are imaged concurrently. While this has been studied in a Traditional Medicare population, it has not been studied in other populations subject to prior authorization. This study explores between-facility variation in ordering and receiving orders to render combined CT in a mixed commercial and Medicare Advantage population.

Methods

Orders for CT abdomen (without/with contrast), CT thorax (without/with contrast), and concurrent CT brain and sinus authorized by a prior authorization company from 2013–2017, pertaining to patients with commercial or Medicare Advantage health plans from one national insurer, were extracted. Orders were issued and rendered by both hospitals and nonhospitals. The analysis was performed separately for each anatomical area in two ways: orders were grouped by ordering facility, and by designated rendering facility. For each facility, the ratio of combined to total orders was calculated, and analysis of variance was used to determine whether there were significant differences in this rate by year. The association between health plan type and combined imaging rates was assessed.

Results

Combined rates [ratio±standard deviation] for abdomen, thorax, and brain/sinus were 0.306±0.246, 0.089±0.142, and 0.002±0.01 respectively when the analysis was conducted according to ordering facility, and 0.311±0.178, 0.096±0.113, and 0.001±0.006 when the analysis was conducted according to designated rendering facility. Combined CT abdomen and CT thorax rates decreased monotonically from 2013 to 2017, decreases that were significant (P < .01) regardless of whether orders were grouped by ordering or rendering facility. Combined CT abdomen and CT thorax rates significantly differed between orders pertaining to people with commercial and Medicare Advantage plans.

Discussion

Variability was greater when orders were grouped by ordering facility, rather than rendering facility. Health plan type may influence whether a patient receives combined CT.

Klíčová slova:

Hospitals – Physicians – Neuroimaging – Computed axial tomography – Outpatients – Medicare

Zdroje

1. Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. New England Journal of Medicine. 2007 Nov 29;357(22):2277–84. doi: 10.1056/NEJMra072149 18046031

2. Hasebroock KM, Serkova NJ. Toxicity of MRI and CT contrast agents. Expert opinion on drug metabolism & toxicology. 2009 Apr 1;5(4):403–16.

3. Abdomen CT-Use of Contrast Material (OP-10). New Haven (CT): Yale-New Haven Health Services Corporation/Center for Outcomes Research and Evaluation; The Lewin Group. 2018 Annual Reevaluation Report. 2018. 25 p. Contract No.: HHSM-500-2013-13018I. Supported by the Centers for Medicare & Medicaid Services.

4. Narayan AK, Rosenkrantz AB, Wang GX, Daye D, Durand DJ. Trends in Hospital Performance on the Medicare National Outpatient Imaging Metrics: A 5-Year Longitudinal Cohort Analysis. Journal of the American College of Radiology. 2019 May 21.

5. Horowitz JM, Kamel IR, Arif-Tiwari H, Asrani SK, Hindman NM, Kaur H, et al. ACR Appropriateness Criteria® Chronic Liver Disease. Journal of the American College of Radiology. 2017 Nov 30;14(11):S391–405.

6. Majdalany BS, Murrey DA Jr, Kapoor BS, Cain TR, Ganguli S, Kent MS, et al. ACR Appropriateness Criteria® Chylothorax Treatment Planning. Journal of the American College of Radiology. 2017 May 1;14(5):S118–26.

7. Akers SR, Panchal V, Ho VB, Beache GM, Brown RK, Ghoshhajra BB, et al. ACR Appropriateness Criteria® Chronic Chest Pain—High Probability of Coronary Artery Disease. Journal of the American College of Radiology. 2017 May 1;14(5):S71–80.

8. Simultaneous Use of Brain Computed Tomography (CT) and Sinus CT (OP-14). New Haven (CT): Yale-New Haven Health Services Corporation/Center for Outcomes Research and Evaluation; The Lewin Group. 2018 Annual Reevaluation Report. 2018. 18 p. Contract No.: HHSM-500-2013-13018I. Supported by the Centers for Medicare & Medicaid Services.

9. de González AB, Mahesh M, Kim KP, Bhargavan M, Lewis R, Mettler F, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Archives of internal medicine. 2009 Dec 14;169(22):2071–7. doi: 10.1001/archinternmed.2009.440 20008689

10. Levin DC, Parker L, Halpern EJ, Rao VM. Are combined CT scans of the thorax being overused?. Journal of the American College of Radiology. 2014 Aug 1;11(8):788–90. doi: 10.1016/j.jacr.2013.12.010 24768077

11. Rosenkrantz AB, Doshi A. Characterizing the performance of the nation’s hospitals in the Hospital Outpatient Quality Reporting Program’s imaging efficiency measures. Journal of the American College of Radiology. 2015 Feb 1;12(2):166–73. doi: 10.1016/j.jacr.2014.08.022 25444060

12. Rosenkrantz AB, Babb JS, Nicola GN, Silva E III, Wang W, Duszak R Jr. Double scan CT rates: An opportunity for facility-based radiologist measures in the Quality Payment Program. Journal of the American College of Radiology. 2018 Mar 1;15(3):429–36.

13. Powell AC, Levin DC, Kren EM, Beveridge RA, Long JW, Gupta AK. 2005 to 2014 CT and MRI Utilization Trends in the Context of a Nondenial Prior Authorization Program. Health Services Research and Managerial Epidemiology. 2017 Oct 9;4:2333392817732018.

14. DME-Rural-Zip-and-Formats. Centers for Medicare & Medicaid Services. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule-Items/DME-Rural-Zip-and-Formats.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending. Published October 21, 2015. Accessed July 20, 2018.

15. Census Regions and Divisions of the United States. U.S. Census Bureau. https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf Accessed June 26, 2019.

16. Powell AC, Hippe DS, Long JW, Robinson JD. Reinitiation of Withdrawn or Modified Neuroimaging Requests After Collaborative Consultation. Academic radiology. 2015 Nov 1;22(11):1433–8. doi: 10.1016/j.acra.2015.08.005 26363823

17. Thorax CT—Use of Contrast Material (OP-11). New Haven (CT): Yale-New Haven Health Services Corporation/Center for Outcomes Research and Evaluation; The Lewin Group. 2018 Annual Reevaluation Report. 2018. 22 p. Contract No.: HHSM-500-2013-13018I. Supported by the Centers for Medicare & Medicaid Services.

18. Graser A, Johnson TR, Hecht EM, Becker CR, Leidecker C, Staehler M, et al. Dual-energy CT in patients suspected of having renal masses: can virtual nonenhanced images replace true nonenhanced images?. Radiology. 2009 Aug;252(2):433–40. doi: 10.1148/radiol.2522080557 19487466

19. Friedman DP, Smith NS, Bree RL, Rao VM. Experience of an academic neuroradiology division participating in a utilization management program. Journal of the American College of Radiology. 2009 Feb 1;6(2):119–24. doi: 10.1016/j.jacr.2008.08.006 19179241