Aug 29, 2023

A physician network is detailing how it piloted a radiology e-consult service for reinterpreting outside imaging exams, which is generating additional revenue and wRVU credits, among other benefits. Boston-based Atrius Health launched the offering in November 2020, performing 222 reinterpretations during an 18-month testing period. Its workflow required rads to place an official report in the electronic medical record, which compared conclusions against those from outside experts. In-house physicians were able to “seamlessly” fit this task into their regular workload, experts detailed in Current Problems in Diagnostic Radiology. E-consults resulted in a change in management recommendations for about 46% of cases. Another 37% led to an endorsement of no further imaging needed or an adjustment in the modality/interval, saving costs and protecting patients from unnecessary radiation. “This pilot program achieved its goal of demonstrating the feasibility of creating an official re-interpretation program to take the place of unofficial ‘curbside consults’ to answer a targeted clinical question or address incidental findings, which can provide value to patients, providers, and the healthcare system,” wrote first author Scott F. Cameron, MD, with the Department of Radiology/Imaging at Atrius, which was recently acquired by Optum. “It would be valuable to see how other healthcare organizations can adapt a similar program to achieve the same aims, particularly as the shift towards value-based care continues.” Cameron and co-author Rebecca K. Schwartz, MD, said the pilot program was limited to CT and MRI exams where there were specific questions relevant to patient care. Re-interpretation orders were created for 30 high-frequency exams. Any instances where there was no prior imaging, or if examinations were more than six months old, were excluded from the analysis. Atrius Health already had a “robust” system in place prior to the pilot, whereby external imaging exams were loaded directly into the PACS. Re-interpretations were typically triggered when the report of an external imaging exam, with recommendation for follow up on an abnormality or incidental finding, reached the patient’s primary care physician. “If that provider has reason to believe that the patient has either internal or other external imaging studies of the same body region, she/he enters a generic radiology e-consult order by filling out the electronic referral in Epic and answering the associated questions,” the study noted. “We provided the PCPs with a one-page handout that we created to help them understand the workflow.” Of the re-interpretations included in the study, 162 covered the body and 60 were neuroradiological. Atrius Health allowed any available radiologist with the necessary skills to handle the task. A total of 11 physicians participated, covering between 1%-29% of total exams at an average of 9% per rad. The most common categorization for body (41%) and neuro exams (31%) was “no change in management recommendations.” “Disagreement with recommendation for further imaging—no further imaging necessary” showed up second most frequently at 21% for whole-body imaging and 25% for neuro. Meanwhile, the reverse, with further imaging recommended on reexamination, occurred between 9%-10% of the time. Commercial insurers paid the entire re-interpretation fee in the majority of cases, and patients “only occasionally” received a bill, the authors noted. It cost about $25.94 per examination for staff to run the program, with operational costs of $5,759 across all 222 cases. Atrius Health saved an estimated $10,961 from avoiding unnecessary follow-up exams, with net savings of more than $5,202. “This pilot program has demonstrated the ability of e-consults to save unnecessary follow-up imaging and associated expense, and, in cases where follow-up imaging was determined to be unnecessary, to reduce patients’ anxiety related to uncertainty of the significance of incidental findings,” the authors noted. “From the radiologists’ perspective, these results were achieved with no more effort than interpreting any other cross sectional imaging exam, since reporting macros were mapped to the appropriate exam type, and the presence of the original outside report and imaging was a pre-requisite for performance of the service. We have received positive informal feedback from ordering providers, who find the program user friendly and reliable.” Read more, including potential study limitations, at the link below.