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Diagnostic Imaging's Weekly Scan: Aug. 7, 2020


Pediatric Imaging Increase, Appropriate Use Criteria, Radiology Residency Pandemic Branding, Snapchatting Emergency Images

Welcome to Diagnostic Imaging. I’m senior editor, Whitney Palmer. Before we get to our highlighted interview of the week on technology tools to improve patient engagement, here are the top stories of the week.

Across the country, the overall use of diagnostic imaging with pediatric patients is on the rise. According to a study published this week in JAMA Pediatrics, investigators from the University of Pittsburgh Medical Center revealed emergency departments are ordering more MRI scans and ultrasounds for children, but the numbers of CT scans are dropping. By examining more than 26 million emergency department records gathered between Jan. 1, 2009, and Dec. 31, 2018, the team calculated ultrasound use increased from 2.5 percent to 5.8 percent of patients, and MRIs increased from 0.3 percent to 0.6 percent. CT fell from 3.9 percent to 2.9 percent, declining in eight areas. Concussion saw a 23-percent drop; appendectomy a 14.9 percent; ventricular shunt procedures fell 13.3 percent, and migraine and other headaches reduced by 12.4 percent. Nervous system disorders dropped by 10.1 percent, abdominal pain by 6.1 percent, ear, nose, and throat by 5.9 percent, and seizure by 5.3 percent. The team also determined that more imaging was used for patients who were ultimately hospitalized.

After several years of waiting, it finally looks like the appropriate use criteria first introduced in the Protecting Access to Medicare Act of 2014 might be approaching full implementation. In a session during the Radiology Business Management Association’s PaRADigm Shift 2020 virtual meeting, coding and reimbursement expert Melody Mulaik, president of Revenue Cycle Coding Strategies, LLC, outlined where the industry sits with testing compliance to these guidelines and the use of clinical decision support. In her presentation, she outlined the G-codes – and the CPT modifiers – that must be included on claims to indicate your referring providers have consulted the appropriate use guidelines. Without these codes, once full implementation occurs, your claims will be denied when you submit for reimbursement. She also outlined several metrics by which you can gauge compliance. She suggested examining utilization by provider and practice both pre- and post-implementation, as well as evaluating primary and secondary payer denials, distinguishing between appropriate use criteria and medical necessity rejections. In addition, she recommended identifying any missing appropriate use criteria information by providers and facility staff to identify where omissions occur most frequently, and segmenting out compliance by modality when appropriate.

Over the past several months, it has become clear that the pandemic has touched radiology in a myriad of ways. In fact, the impact has seeped down to the residency program level as potential applicants and program directors are struggling to find alternative ways to meeting in person. In an article published in the Journal of the American College of Radiology, a multi-institutional group of residency program leaders pointed to several tactics residency programs of all sizes can use to distinguish themselves from the pack when online interaction is the only format available. In addition to keeping static websites up-to-date with the latest program information, the program directors highlight social media and video conferencing as effective tools, as well. With social media they advocated for recruiting current residents and faculty to create photographic, written, and video material that can showcase the program’s high points. Featuring resident achievements on Facebook, Twitter, and Instagram accounts – especially those manned by the residents themselves – can also be effective. For video conferencing, the directors suggested standardizing backgrounds and equipment, as well as incorporating institutional logos. Using video tools to conduct mock interviews, host question-and-answer sessions with individuals who have recently gone through the Match, and plan virtual happy hours are also great ways to give potential applicants and clear idea about personality of a residency program.

And, social media is making headway into radiology beyond helping residents choose a program. In a new study published in Emergency Radiology, investigators from Louisiana State University Health New Orleans School of Medicine tested whether the time-constrained app Snapchat could be an effective tool in training residents in emergency room image interpretation. The answer is yes. During a four-week study, researchers presented seven residents – four juniors and three seniors – with five emergent radiologic cases using Snapchat and five similar cases using an overhead projector in the classroom. Across the board, the residents performed better with Snapchat. The cumulative score among juniors was 81 out of 160 with the app and only 63 with the classroom projector. For seniors, their cumulative score was 88 out of 120 with Snapchat and 75 with the projector. The hope, the researchers said, is that these results will help promote active learning and engagement in remote teaching environments.

And, finally, this week Diagnostic Imaging looked at the efforts to improve care delivery, specifically with patient engagement. In today’s environment, technology has become a powerful tool in improving these interactions. Across the board, it is being used to augment patient knowledge, skills, and interest in participating in his or her healthcare. Not only does it enhance communication with patients, making them feel more empowered, but it can also increase patient satisfaction rates. We spoke with Dr. Alexander Towbin, associate chief of clinical operations and informatics and chair of radiology informatics at Cincinnati Children’s Hospital Medical Center about his facility’s experience with the role of technology in patient engagement, as well as some best practices. Here’s what he shared.

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