Researchers from Massachusetts General Hospital set out to quantify referral leakage -- care performed out of network for patients who typically receive care in network -- for CT and MRI studies, and to determine if CDS systems were a factor in leakage, said presenter Dr. Anand Prabhakar.
"This is critical to understand in an era of alternative payment models such as [accountable care organizations] and risk-shared contracts," Prabhakar told AuntMinnie.com. "Furthermore, Medicare will mandate clinical decision support for imaging in 2017."
The researchers performed a large retrospective analysis of imaging studies from 2011 to 2013 that were given a low appropriateness score by their institution's outpatient CDS system and were then canceled by the ordering physician. They then cross-referenced the imaging utilization scores for patients in the risk-contract insurance database to determine if they had subsequently received outpatient imaging -- contrary to the CDS recommendation -- elsewhere within 60 days of the original order.
CT/MRI studies that had low CDS scores were not leaked out of the network, Prabhakar said.
"Therefore, institutions can feel comfortable implementing order-entry CDS for Medicare and non-Medicare populations without fear of driving imaging studies outside of their institution," he said.
