Israeli HMO adopts ACR imaging criteria

Maccabi Health Care Services, the second largest HMO in Israel, saw utilization of CT and MR decrease after it implemented American College of Radiology appropriateness criteria in 2002.

CT use dropped 33% and MR use fell 8.7% in the 23 months after preauthorization requirements were instituted for the two modalities, Dr. Arve Blacher said at the 2004 RSNA meeting. Costs associated with the two procedures represented 1.4% of the provider's healthcare budget.

Referring physicians must phone in MR and CT requests to a central site for authorization. The call center staff responds with either an immediate authorization or a deferral followed by a written explanation.

A phone discussion with a radiologist to explain the decision is available on demand. In disputed cases, the referring physician may still order CT, but MR imaging may not be performed until after the disposition of an appeal.