Utilization Management and ACR Select.

Abstract

The ACR, published as ACR Select, provides an industry standard for imaging and through its experience with Appropriateness Criteria, is positioned to respond quickly to changing market demands. It has added hundreds of clinically relevant indications to ensure that even common scenarios have coverage. ACR Select is inclusive of numerous other credible content sources and actively receives vetted criteria from other medical specialty societies. ACR Select is well established in the market and available for integration into multiple physician access points. It also has support for the provisions and requirements of PL113-93. Healthcare providers have adopted ACR Select within their physician access points to deliver higher quality imaging services and understand the impact that imaging has on the overall care cycle. This better positions these providers to participate in risk-based contracts based on the value that appropriate imaging delivers. With the passage of PAMA, Congress has set a powerful precedent that has created the opportunity for every healthcare payer to transform the way imaging utilization is managed. Physicians will be required to consult Appropriateness Criteria delivered through CDS when placing orders for HTDI exams for Medicaid patients, and this can easily extend across the entire payer mix. PAMA has passed into public law (PLI113-93) and represents an opportunity for healthcare providers to develop risk based payment models across all imaging services, regardless of the payer of the claim or care setting.