The ACR Radiology Support, Communications and Alignment Network (R-SCANTM) empowers radiologists to take the first step in building a collaborative and consultative relationship with their referring clinicians. The turn-key, clinically relevant projects are the ideal way to introduce imaging appropriateness, clinical decision support and radiologist-led education to fellow care-givers.
With funding from a $2.9 million Department of Health and Human Services (DHHS) grant, under the Transforming Clinical Practice Initiative (TCPI), R-SCAN places the ACR and its member radiologists in partnership with 38 other grantees ranging from sister professional medical organizations to regional care providers. By recruiting 4000 radiologists over a 4-year award period, and with each radiologist bringing four referrers into the network, ACR will support 24,000 clinicians through the transition from traditional volume-based to value-driven practice.
Through R-SCAN, participants will also have access to the resources of their local and regional Practice Transformation Network organizations to support the culture change and workflow redesign necessary for participation in value-based payment models. The network concept advanced under the TCPI program and exemplified by R-SCAN connects radiologists and referrers in pursuit of appropriate image ordering for 10 specific Choosing Wisely topics.
Max Wintermark, MD, chief of neuroradiology at Stanford University developed the concept, initially as a track within the ACR 2015 meeting, to demonstrate how practicing radiologists could be part of a national research activity. The ACR’s Value-Based Practice Quality Improvement project morphed to R-SCAN when the grant opportunity arose. Key to program success and the grant award is the connection of a step-by-step program to relevant clinical situations that can be improved through care coordination with clinical decision support and radiologist consultation.
For example, one R-SCAN topic is the Choosing Wisely guidance developed by ACR, the American College of Emergency Physicians, and the American Academy of Pediatrics to avoid CT scans in the emergency room in pediatric patients with minor head injury. This topic marries the evidence gathered in close cooperation with professional medical organizations and supports that same collaboration around actual clinical activity based on well-defined clinical performance measures .
Participants follow a step-by-step process that is entirely web-based. Designed to be meaningful to encourage a change in practice but streamlined to avoid unnecessary clerical duties, the complete process for each topic generally requires 12-15 hours of radiologist time.
All R-SCAN participants receive free access to ACR Select®, a clinical decision support tool supported by the ACR Appropriateness Criteria®. In the first phase of the project, radiologists and referrers agree to work on one of the 10 Choosing Wisely topics. Often these are topics that their institution, health system or quality organization has determined require improvement, so R-SCAN helps these participants satisfy larger organizational quality objectives. Radiologists then harvest a minimum of 25 previously performed cases in the topic and score them using the ACR Select web-based tool.
Scoring typically takes less than one minute per case. In the future, facilities with ACR Select installed will be able to transmit data directly to R-SCAN. R-SCAN delivers a report for radiologist quality improvement analysis along with the educational resources needed for the second phase of the project. The R-SCAN website links participants with white papers that summarize imaging evidence, PowerPoint® presentations that describe the best imaging options for specific clinical scenarios and podcasts that solve imaging order problems to help referrers make better choices when ordering imaging exams.
R-SCAN complements the ACR’s Imaging 3.0 Initiative by empowering radiologists as stewards of imaging, optimizing the effectiveness of recommended diagnostic imaging, and demonstrating their leadership and expertise.
It also prepares participants to comply with the federal Medicare Access and CHIP Reauthorization Act (MACRA) and Protecting Access to Medicare Act (PAMA). MACRA sets the terms for Medicare’s transition to value-based payments and requires radiologists and other physicians to present concrete data documenting how modifications to their practices are leading to better and less expensive patient care. PAMA will eventually require ordering clinicians who rarely consult appropriateness use criteria (AUC) to do so for advanced imaging order reimbursement.
“Whether a practice is planning to qualify for Merit-based incentive Payment System (MIPS) bonus payment or the alternative payment model incentive, participation in R-SCAN is an excellent way to start preparing,” said Geraldine McGinty, MD, FACR, chair of the ACR Commission on Economics.
For practices that already use clinical decision support, R-SCAN can serve as a first step for tracking and improving AUC adherence. Participants also have an opportunity to earn American Board of Radiology-approved Maintenance of Certification Part 4 credit.
ACR members are invited to register at rscan.org. Questions may be addressed to RSCANinfo@acr.org.