Diagnostic Radiology: The Importance of Managing Costs and Quality

Diagnostic Radiology: The Importance of Managing Costs and Quality

by Robyn Lira, Vice President
Original Article Published: July/August 2015, Building Indiana

When an employee is injured or suffering from a medical condition, the number one priority is to provide immediate and proper medical treatment, so they can recover to good health and return to work as quickly as possible.

Diagnostic tests such as magnetic resonance imaging (MRI) and computed tomography (CT) scans have revolutionized the way physicians detect, diagnose and treat diseases and injuries. These scans produce detailed images of organs, tissue, the vascular system, abdomen, and bones. Imaging can serve as the critical first step to ensure patients receive an accurate diagnosis and appropriate medical care. Scans are particularly important in workers’ compensation, where work-related injuries are often muscular or skeletal in nature, and require imaging for assessment.

However, unprecedented growth in the use of diagnostic radiology has contributed to rising costs. The Association of Health Insurance Plans reports almost $100 billion per year is spent on diagnostic imaging in the U.S. Inflation in this area contributes to spiraling costs in workers’ compensation and group health, making savings a top priority.

In addition, studies show that if quality standards are not in place, scans may fail to provide necessary information. In some instances, poor quality images and/or misinterpreted scans can cause confusion. For instance, an MRI can ascertain the nature and extent of an injury, but a quality image and credentialed radiologist must be part of this equation. Otherwise, the injury may be misdiagnosed, become worse, and delay the employee’s return to work, or result in a permanent disability.

How can you manage cost and quality of diagnostic imaging for your company?

Many companies have chosen to partner with a specialized diagnostic network that ensures both quality and savings. Such a network can enable a faster, more efficient resolution for the patient, providing them with an optimal level of care, service and convenience. As a result, savings are delivered in four key areas:

  1. Returning a worker to the job promptly and safely, reducing the time and costs associated with prolonged absence
  2. Administrative savings realized via the network’s coordination of appointments and results
  3. Quality standards that ensure tests are done right the first time
  4. Discounts that deliver significant cost savings per scan

These benefits are achieved with the following strategies:

A managed referral process to maximize savings for employers and insurance programs.

There are generally three types of providers that perform diagnostic imaging: hospitals, physician offices, and freestanding imaging facilities.

“We often find that employers and their programs’ administrators don’t always know where to send workers who need radiology procedures, such as MRI and CT,” said John Stanzi, President of Diagnostics at One Call Care Management. “Injured workers may be directed to a hospital, not realizing that the same test can be performed with the same great equipment and equally qualified clinical staff at a more cost-effective freestanding imaging facility.”

A specialized diagnostic network will have a database that contains thousands of provider profiles, including freestanding imaging facilities. The network utilizes a quality-driven referral process that ensures employees are placed with the best, most qualified providers each and every time.

According to an analysis performed by One Call Care Management, in-network referrals have saved an average of 55.4% per imaging service within the state of Indiana. Employers and their insurance companies reap savings without having to dramatically revamp their programs or transfer costs to employees.

Rigorous credentialing ensures patients utilize quality imaging facilities.

A diagnostic network contracts with and provides access to only highly qualified and credentialed imaging facilities. To be admitted into the network, imaging centers and radiologists must undergo a rigorous credentialing process. The network employs standards that meet or exceed those used by organizations, such as the National Committee for Quality Assurance (NCQA). It also consults resources, such as American Medical Association (AMA) and National Practitioner Data Bank (NPDB), to verify a provider’s credentials, licensure, and memberships.

The network keeps track of providers that maintain American College of Radiology (ACR) accreditation, and when necessary, will perform additional audits to ensure providers meet quality guidelines and clinical standards. The network also balances a variety of other quality factors, including age of equipment, software updates, strength of an MRI determined by magnet strength, expertise of the reading radiologist, assurance that facilities adhere to quality protocols, and feedback on patient service.

An advocacy program to assess and meet specific patient needs.

A diagnostic network offers a call center staffed with care coordinators to help patients schedule appointments often on the same day, and identify conveniently located facilities that have the appropriate equipment. Patients receive compassionate, personalized service and can rest assured, knowing they have been referred to a reputable facility.

“We feel imaging centers should strive to deliver quality care and a superior patient experience,” said Julie Bieszczat, president and owner of Northwestern Medical Imaging. “Patients should be made to feel at home and taken care of, as soon as they walk in the door. Engagement in the Indiana community is also critical in helping to educate the community about medical conditions, such as multiple sclerosis, where radiology can aid in diagnosis and treatment.”

Scan of the Future: Quality Matters

Innovations in diagnostic radiology have led to many advances in healthcare. However, without careful selection of an imaging center, quality can often be a concern, and costs can spiral out of control. Your organization can easily improve results by leveraging a specialized diagnostic network, which will refer your employees to only the best, most qualified imaging facilities—focused on giving your employees the care and attention they deserve.