Support Decisions, Already

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One of my great frustrations in observing radiology over the past 15 years has been the specialty’s failure to take charge of utilization management. In abdicating responsibility, the specialty opened the door to radiology business management companies, conflicting and opaque interpretations of medical necessity, and suspicions that money, not science, was driving denials.

While I and others were busy wringing their hands, the radiologist community was compiling a vast library of evidence-based guidelines, the ACR Appropriateness Criteria®, a monumental task that has taken many thousands of physician hours and the combined resources of the American College of Radiology and many other specialty and subspecialty organizations.

There are 180 topics (from breast to vascular imaging) with more than 850 variants in the June 2012 version, and the big news is that the AC are now electronic-ready (thanks to the tireless work of Chris Sistrom, MD, PhD, etc) and available for licensing as the ACR Select® through a new company called the National Decision Support Company. NDSC is run by Mike Mardini, an industry veteran and serial entrepreneur who got his feet wet in decision support when running a speech-recognition company called Commissure, which he sold to Nuance, which stopped supporting the decision-support technology (RadPort) earlier this year. Mardini picked up a couple of key former employees; I spoke to one of them, Vic Panza, at the show. Panza is also an alumna of at least one RBM company.

“The ACR made the decision to get in the game, build a comprehensive clinical content rule set, and make it consumable digitally,” Panza says. “ACR Select is a clinical content rule set, not a platform. In order to use it, you have to have access.”

The ACR chose NDSC as its commercial partner to license the software to EMRs and other health IT companies (Medicalis and Health Fortis, for instance) interested in providing access. NDSC also provides a cloud-based access portal, a bare-bones, speech-enabled platform that is easy to access and priced on a per-click basis.
Panza reports that NDSC is speaking to many hospitals all over the country. “They are looking at it to manage inpatient and ED imaging,” Panza says.

Carpe diem! Here lies an opportunity for radiology practices to take charge of (and responsibility for) imaging appropriateness.