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    With Updated Use Criteria, 30% of Echo Tests Inappropriate: Michael O'Riordan

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    Ricardo Vivancos Delgado
    The study found that around 30% of stress echocardiography tests ordered at one academic institution were inappropriate according to updated ACC guidelines. While the updated 2011 ACC criteria improved classification of tests, they did not impact the number of inappropriate tests ordered over a three-year period. There was also only moderate correlation between the ACC criteria and guidelines used by radiology benefits managers to determine insurance coverage. Around 30% of tests continued to be ordered for inappropriate reasons, suggesting more consistency is needed between clinical guidelines and insurance coverage policies.

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    With Updated Use Criteria, 30% of Echo Tests Inappropriate: Michael O'Riordan

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    Ricardo Vivancos Delgado
    42 views1 page
    The study found that around 30% of stress echocardiography tests ordered at one academic institution were inappropriate according to updated ACC guidelines. While the updated 2011 ACC criteria improved classification of tests, they did not impact the number of inappropriate tests ordered over a three-year period. There was also only moderate correlation between the ACC criteria and guidelines used by radiology benefits managers to determine insurance coverage. Around 30% of tests continued to be ordered for inappropriate reasons, suggesting more consistency is needed between clinical guidelines and insurance coverage policies.

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    The study found that around 30% of stress echocardiography tests ordered at one academic institution were inappropriate according to updated ACC guidelines. While the updated 2011 ACC criteria improved classification of tests, they did not impact the number of inappropriate tests ordered over a three-year period. There was also only moderate correlation between the ACC criteria and guidelines used by radiology benefits managers to determine insurance coverage. Around 30% of tests continued to be ordered for inappropriate reasons, suggesting more consistency is needed between clinical guidelines and insurance coverage policies.

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    42 views1 page

    With Updated Use Criteria, 30% of Echo Tests Inappropriate: Michael O'Riordan

    Uploaded by

    Ricardo Vivancos Delgado
    The study found that around 30% of stress echocardiography tests ordered at one academic institution were inappropriate according to updated ACC guidelines. While the updated 2011 ACC criteria improved classification of tests, they did not impact the number of inappropriate tests ordered over a three-year period. There was also only moderate correlation between the ACC criteria and guidelines used by radiology benefits managers to determine insurance coverage. Around 30% of tests continued to be ordered for inappropriate reasons, suggesting more consistency is needed between clinical guidelines and insurance coverage policies.

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    of 1

    Pgina 1 de 2

    www.medscape.com

    With Updated Use Criteria, 30% of Echo Tests Inappropriate


    MichaelORiordan

    Feb22,2013

    MIAMIAstudyevaluatingtheutilizationofstressechocardiographyatoneacademicinstitutiondemonstrated
    thatrevisionstotheolderAmerican College of Cardiology(ACC)appropriate-usecriteriaenabledalmostall
    previouslyunclassifiablestressechocardiogramstonowbeclassified[1].Thissuggeststhattheupdated2011
    criteriahaveincreasedvalueasbothadecisionaidforcliniciansandaguidetoreimbursementjudgmentsby
    healthplans,sayresearchers.
    However,theupdatedcriteriadonotappeartohavehadanimpactonthenumberofimagingtestsrequested
    forinappropriatereasons.Approximatelyone-thirdofstress-echocardiographictestswereorderedfor
    inappropriateindications.
    "Therevisedcriteriarepresentimprovementsthatmaypotentiallyhelpcliniciansaswellashealthplansusing
    themindecisionmaking.However,wewerenotabletodemonstratethatthepublicationofthenewappropriateusecriteriahadasubstantialimpactonutilizationpractices,atleastinourinstitution,"leadinvestigatorDr
    Howard Willens(UniversityofMiamiMillerSchoolofMedicine,FL)toldheartwire ."Twoiterationsofthe
    criteria,aswellasacasualeducationinitiative,didnotimpactutilizationoverathree-yearperiod."
    Inaddition,theresearchersfoundonlyamoderatedegreeofcorrelationbetweenthe2008and2011
    appropriate-usecriteriaforstressechocardiographyandtheradiologybenefits'manager(RBM)precertification
    guidelines.Accordingtotheiranalysis,12.9%and41.9%ofthestress-echocasesclassifiedasappropriateor
    uncertainusingthe2008criteriawouldnothavereceivedpreauthorizationaccordingtotheguidelinesofthe
    companiesevaluatedinthisreport.
    "Thereisaneedformoreconsistencybetweenthehealthplanprecertificationguidelinesforstress
    echocardiographyandthecarefullywritten,scientificallybasedappropriate-usecriteria,"saidWillens.
    Inaneditorialaccompanyingthestudy[2],Dr James Min(Cedars-SinaiMedicalCenter,LosAngeles,CA)
    explainsthatRBMsareusedbyprivatepayerplansandrequirepreauthorizationofcoronaryarterydisease
    imagingtestssuchasstressechocardiographytoensurecoverage.AlthoughtheRBMsaresupposedlybased
    ontheACCappropriate-usecriteria,theyhavebeencriticizedfordifferencesbetweentheACCcriteriaandthe
    RBMguidelines.GiventhatthecorrelationbetweentheRBMandACCcriteriawasonlyfair,thislackof
    consistencycanbefrustratingforphysicians.
    However,MinwritesthatalthoughareindeeddrawbackstotheRBMprocess,allowingcarte-blancheordering
    ofimagingtests--thepenchantforusingnoninvasivetestingmodalitieshasresultedinan"unbridled
    consumptionofcoronaryarterydiseaseimagingresources,"henotes--isproblematic.Hecitestheevidencethat
    thenumberofinappropriateindicationsforstressechodidnotdeclineinthestudybyWillensandcolleagues,
    withapproximatelyone-thirdofthetestsorderedforinappropriateindications.
    Thedebateoverjustwhatpercentageofechocardiogramsaremedicallyneededisgaininglotsofattention
    thesedays,includingalivelydiscussiononthetheheart.orgfollowingablogpostbyeditorinchiefDr Eric
    Topol(ScrippsTranslationalScienceInstitute,LaJolla,CA).AsMinnotesinhiseditorial,theuseofdiagnostic
    imagingisincreasingmorerapidlythanotheraspectofcare,withnoninvasivestressechoincreasing6.1%
    annuallybetween1993and2001.
    Assessment of the 2008 and 2011 Criteria
    Inthestudy,publishedonlineFebruary20,2013intheJournal of the American College of Cardiology:
    Cardiovascular Imaging,Willens,alongwithDrs Katarina NelsonandRobert Hendel(UniversityofMiami
    MillerSchoolofMedicine),soughttoevaluatetheutilizationofstressechoattheirinstitutionandtoevaluatethe

    http://www.medscape.com/viewarticle/779746_print

    4/3/2013

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