1. An Introduction to: rscan.org

2. What is R-SCAN? 2 A clinical practice improvement activity for radiologists and referring practitioners to:  Improve imaging appropriateness  Gain experience with clinical decision support (CDS) technology  Optimize imaging care of our patients  Reduce unnecessary imaging exams  lower the cost of care.

3. Why Participate?  Collaborate with referring practitioners to provide the best imaging care  All the tools and resources needed are on the R-SCAN website: rscan.org  Obtain free access to ACR Select clinical decision support (CDS) Web portal  Earn ABR-approved Maintenance of Certification (MOC) Part 4 credit  Prepare for the future of value-based payment models  Recent legislation increasingly ties reimbursement to delivery of better coordinated care at lower cost  Medicare Access & CHIP Reauthorization Act (MACRA) of 2015  Protecting Access to Medicare Act (PAMA) of 2014 3

4. How is R-SCAN Supported?  R-SCAN was awarded a CMS grant as part of its Transforming Clinical Practice Initiative (TCPI).  TCPi Goals: 4

5. How Does R-SCAN Work? 5  All the tools and materials are available on the new R-SCAN website: rscan.org  Participation in R-SCAN is free—both for radiologists & for referring practitioners.  A step-by-step guide leads you through the process of improving the ordering of appropriate imaging exams based on the 11 Choosing Wisely ® recommendations.

6. How Does It Work?  R-SCAN participants use a customized version of the ACR Select™ clinical decision support to rate imaging exams ordered.  The electronic version of the ACR Appropriateness Criteria ® 6

7.  Participants rate the appropriateness of exams ordered before and after an educational program  Project reports are created showing progress  Reports can be shared with colleagues, hospital administrators, insurers 7 How Does It Work?

8. The Choosing Wisely Topics 8 Specialty Area Choosing Wisely Topic Chest ImagingAvoid admission or preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam. Chest ImagingDo not perform chest CT angiography to evaluate for possible pulmonary embolism in patients with a low clinical probability and negative results of a highly sensitive D-dimer assay Cardiac Imaging Don’t use coronary CT angiography in high-risk* patients presenting in the emergency department with acute chest pain. Trauma Imaging Avoid the routine use of “whole-body” diagnostic CT scanning in patients with minor or single-system trauma Genitourinary Imaging Don’t perform follow-up imaging for clinically inconsequential adnexal cysts.

9. The Choosing Wisely Topics Specialty AreaChoosing Wisely Topic Genitourinary Imaging Don’t perform PET, CT, and radionuclide bone scans in the staging of early prostate cancer at low risk for metastasis. Musculoskeletal Imaging Don’t perform advanced imaging of the spine within the first 6 weeks in patients with nonspecific acute low back pain in the absence of red flags. NeuroimagingDon’t order sinus CT or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis. NeuroimagingCT scans are not necessary in the immediate evaluation of minor head injuries NeuroimagingNeuroimaging (CT, MRI) is not necessary in a child with simple febrile seizure. NeuroimagingDon’t do imaging for uncomplicated headache.

10. More About PAMA  CMS to require consultation of appropriate use criteria (AUC) in the ordering of advanced imaging exams  A condition for reimbursement to imaging physicians.  Will require “outlier” ordering providers (low AUC adherence) to obtain prior authorization from CMS before advanced imaging orders can be performed.  For practices that already have CDS installed, R-SCAN can serve as an important first step for tracking and improving adherence with AUC. 10

11. From the ACR Leadership 11 R-SCAN participation is an excellent starting point for practices looking to succeed in a value-based payment world. Geraldine B. McGinty, MD, MBA, FACR Chair, ACR Commission on Economics R-SCAN provides a truly turnkey methodology for radiologists and referring physicians to form enduring collaborations that result in measurably improved imaging utilization and patient care. Max Wintermark, MD, MBA R-SCAN Clinical Advisor R-SCAN provides an enormous opportunity for radiologists, working with referring health care professionals, to lead medicine in making significant change that positively impacts patients. William T. Thorwarth Jr., MD, FACR ACR Chief Executive Officer

12. Question or to learn more  Contact: RSCANinfo@acr.org or Nancy Fredericks nfredericks@acr.org  Visit: www.rscan.org Thank you! 12