National insurer endorses ACR appropriateness criteria

January 17, 2005

One of the nation’s largest insurers will begin promoting the American College of Radiology’s appropriateness criteria and accreditation to its network of physicians and healthcare professionals. The move by UnitedHealth Group is an attempt to rein in skyrocketing imaging costs and overutilization.

One of the nation's largest insurers will begin promoting the American College of Radiology's appropriateness criteria and accreditation to its network of physicians and healthcare professionals. The move by UnitedHealth Group is an attempt to rein in skyrocketing imaging costs and overutilization.

ACR's criteria are used to determine the most appropriate imaging exams for diagnosis and treatment. Representatives of both the ACR and the Minneapolis-based UnitedHealth Group say that following the criteria should eliminate many unnecessary procedures.

"UnitedHealth chose the ACR appropriateness and accreditation criteria because we wanted to facilitate the dissemination and adoption of the best evidence-based medicine," said Reed Tuckson, senior vice president of consumer health and medical care advancement at UnitedHealth. "The best strategy and approach to improving healthcare quality is to base initiatives on strict scientific evidence under the guidance of expert physicians."

It's not surprising that the national insurer would turn to the radiology group for imaging guidance, said Dr. James Borgstede, chair of the ACR board of chancellors.

"Clearly, they are hemorrhaging from an increase in imaging utilization. And this increase is due to a fair amount of inappropriate imaging," he said. "UnitedHealth is a data-driven organization, and we are an organization that has the ability to gather data and has an objective approach to this issue."

The insurer also plans to assess the ACR accreditation status of healthcare facilities. The group wants to not only identify which facilities are providing optimal imaging service, but to provide concrete feedback for facilities that deviate from best practices.

"We are very excited that the leadership of the ACR is stepping up to the plate in order to make a profound difference in the quality and safety of diagnostic imaging," Tuckson said.

The collaboration, announced in December, is the result of a multistep effort on the part of the ACR to curb rampant self-referral, Borgstede said.

The ACR is also working with other insurers to promote its appropriateness criteria and is developing a pilot program with Blue Cross/Blue Shield.

For more information from the online Diagnostic Imaging archives:

Utilization management involves more people in imaging choices

Utilization review takes aim at imaging expenses

Radiology faces challenge to keep role in cardiac MR, CT

New Stark rules address self-referral exceptions