E-QUAL Avoidable Imaging Kick Off Rural Avoidable Imaging

E-QUAL Emergency Quality Network National quality movement, supported by CMS Enrolling over 24,000 Emergency clinicians over the next 4 years to participate in quality improvement activities focused on: Improving outcomes for patients with sepsis Reducing avoidable imaging in low risk patients by implementation of ACEP’s Choosing Wisely recommendations Improving the value of ED evaluation for low risk chest pain by reducing avoidable testing and admissions What is EQUAL

We have enrolled in E-QUAL Our next quality improvement project is on Reducing Avoidable Imaging Our plan: Utilize E-QUAL resources to: Reduce avoidable imaging + report our data = meet CMS requirements = increase our revenue!

Why did we join E-QUAL? To improve our ability to reduce low-value imaging and to increase our revenue Meet CMS requirements E-QUAL initiatives are aligned with CMS hospital quality reporting and payment initiatives Improve revenue Improve patient outcomes Rural-specific resources and support Best practices, rural considerations, implementation assistance Reduction in liability through standardization CME & MOC credits

E-QUAL and MOC Part IV Credit E-QUAL will be listed on the ABEM drop down list of opportunities ED Director will need to be listed attesting that the individual participated in E-QUAL. E-QUAL hopes to develop “automatic” credit soon E-QUAL and CME Credit All E-QUAL webinars/podcasts will be associated with eCME credit. To obtain credit visit the E-QUAL homepage

Why are we quality reporting? There is a new Medicare physician reimbursement program – links quality to reimbursement This is the Merit-based Incentive Payment System (MIPS) Concept behind MIPS High quality care + data reporting = better MIPS performance = larger Medicare reimbursement

MIPS Merit-based Incentive Payment System New Medicare reimbursement program that links quality and data reporting to reimbursement Medicare reimbursement Automatic reimbursement increases from 2015-2019 After 2019, reimbursement will be based on our performance under MIPS MIPS has two categories for measuring the performance of Emergency clinicians Quality Sepsis care is one of the quality measures Clinical Practice Improvement Activities (CPIA) E-QUAL is likely a high-value CPIA E-QUAL is considered an activity for CPIA

Avoidable Imaging Goal: Choosing Wisely: To reduce testing and imaging with low risk patients through the implementation of EM specific Choosing Wisely Recommendations Choosing Wisely: Initiative of the ABIM Foundation and Consumer Reports Aim to advance national dialogue on avoiding unnecessary tests, treatments, procedures Identified “Top 5” list from nine specialty societies

What are the targets for avoidable imaging? Reduce use of high-cost imaging for low back pain Reduce head CT scan after minor head injury Reduce head CT scan after syncope Reduce chest CT for pulmonary embolus Reduce abdominal CT for renal colic

Current state of avoidable imaging Advanced imaging (CT, MRI) have been identified as areas of overuse Implementation of utilization management tools (clinical decision rules) are linked to a reduction in avoidable imaging Example: Pulmonary Embolism (PE) & CT use 1/3 of imaging performed for suspect PE can be categorized as avoidable Application of Wells Criteria and PERC rule can reduce avoidable CT use in assessing for PE

What will we gain from E-QUAL’s avoidable imaging rural series? Guidelines and Materials From Choosing Wisely, ACEP, PECARN Educational Resources and Lectures for CME Update on most recent Imaging literature Data collection tools Patient Engagement materials Webinar/Podcast series Initiation & implementation of avoidable imaging initiatives

What Interventions Could We Implement to Improve Care? Implementation of a standard diagnostic algorithms for several of these conditions Pulmonary embolism & CTs Wells Criteria and PERC rule for PECT Head injury & CTs PERCARN rule for pediatric head trauma New Orleans Head Injury rule for adult head trauma Low-radiation, low-resource alternative modality Use of Ultrasound instead of CT for renal colic Leverage CEDR and E-QUAL data analytics tools to provide feedback to providers