Will Decision Support Deflect Preauthorization?
Decision support might be able to remove the target taped to radiology’s back, according to a tandem presentation that was made by two of the specialty’s respected leaders on May 3, 2010, at the annual meeting of the American Roentgen Ray Society in San Diego, California. Pat A. Basu, MD, MBA, explained how that target came to be there in the first place; he presented “Overutilization: Background, Trends, and Causes.”
Basu, an attending radiologist at Stanford University Medical Center and at the VA Palo Alto Health Care System in California, is Stanford University’s course director of health finance, policy, and economics. Now serving as a White House fellow and special assistant to the president, he is the first radiologist to be appointed to that position. By understanding the reasons for radiology’s current struggles, he says, both individual radiologists and health-care organizations can begin to find ways to identify and correct inappropriate utilization of imaging.
James H. Thrall, MD, provided a real-world example of how decision support could help decrease radiology’s vulnerability to external control (or outright attack) and declining reimbursement, presenting “Opportunities for Reducing Over-utilization.” Thrall is radiologist-in-chief at Massachusetts General Hospital (MGH) in Boston and Juan M. Taveras professor of radiology at Harvard Medical School.
Even if the overutilization of imaging is a problem created largely outside radiology by self-referring nonradiologists, patients’ underinformed demands, and referrers’ errors and malpractice worries, it has become radiology’s problem because radiologists bear the brunt of measures meant to curb utilization, Thrall notes. In clarifying the need for radiology practices to move beyond simply accepting overutilization as part of keeping referring physicians happy (or as part of maintaining current revenue levels), he says, “It’s not a sound business principle to try to build a practice or a business based on things people don’t need—on providing services that are unnecessary.”
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