Closing the Loop on Unscheduled Diagnostic Imaging Orders: A Systems-Based Approach

Financial Impact of a Radiology Safety Net Program for Resolution of Clinically Necessary Follow-up Imaging Recommendations

OBJECTIVE

Health care safety net (SN) programs can potentially improve patient safety and decrease risk associated with missed or delayed follow-up care, although they require financial resources. This study aimed to assess whether the revenue generated from completion of clinically necessary recommendations for additional imaging (RAI) made possible by an IT-enabled SN program could fund the required additional labor resources.

METHODS

Clinically necessary RAI generated October 21, 2019, to September 24, 2021, were tracked to resolution as of April 13, 2023. A new radiology SN team worked with existing schedulers and care coordinators, performing chart review and patient and provider outreach to ensure RAI resolution. We applied relevant Current Procedural Terminology, version 4 codes of the completed imaging examinations to estimate total revenue. Coprimary outcomes included revenue generated by total performed examinations and estimated revenue attributed to SN involvement. We used Student's t test to compare the secondary outcome, RAI time interval, for higher versus lower revenue-generating modalities.

RESULTS

In all, 24% (3,243) of eligible follow-up recommendations (13,670) required SN involvement. Total estimated revenue generated by performed recommended examinations was $6,116,871, with $980,628 attributed to SN. Net SN-generated revenue per 1.0 full-time equivalent was an estimated $349,768. Greatest proportion of performed examinations were cross-sectional modalities (CT, MRI, PET/CT), which were higher revenue-generating than non-cross-sectional modalities (x-ray, ultrasound, mammography), and had shorter recommendation time frames (153 versus 180 days, P < .001).

DISCUSSION

The revenue generated from completion of RAI facilitated by an IT-enabled quality and safety program supplemented by an SN team can fund the required additional labor resources to improve patient safety. Realizing early revenue may require 5 to 6 months postimplementation.

Patient and System Factors Associated With Completed Follow-Up of Probably Benign (BI-RADS 3) Breast Imaging Findings

OBJECTIVE

Evaluate patient factors and health system test ordering and scheduling processes associated with completed BI-RADS 3 breast imaging follow-up.

METHODS

Retrospective review of reports from January 1, 2021, to July 31, 2021, identified BI-RADS 3 findings corresponding to unique patient encounters (index examinations). The electronic health record was queried for patient, examination, and health system ordering or scheduling data including follow-up order status (order placed, performed; order placed, scheduled, but not performed; order placed, unscheduled; no order placed); ordering provider specialty and health system affiliation (primary care versus other, internal versus external to health system); and ordering department (radiology staff versus referring physician staff). Patient home addresses were categorized by area deprivation index (University of Wisconsin's Neighborhood Atlas). Univariable and multivariable analysis identified patient, examination, and ordering or scheduling factors associated with completed follow-up imaging within 15 months of BI-RADS 3 assessment.

RESULTS

There were 3,104 unique BI-RADS 3 assessments, 2,561 (82.5%) with completed BI-RADS 3 follow-up within 15 months of study examination. In multivariable analysis, factors associated with incomplete follow-up included ultrasound (odds ratio [OR] 0.48; 95% confidence interval [95% CI] 0.38-0.60; P < .001) and MRI (OR 0.71; 95% CI 0.50-1.00; P = .049) versus mammogram; patients living in the highest disadvantaged neighborhoods (OR 0.70; 95% CI 0.50-0.98; P = .04); patients <40 years (OR 0.14; 95% CI 0.11-0.19; P < .001); Asian race (OR 0.55; 95% CI 0.37-0.81; P = .003); order placement >3 months (OR, 0.05; 95% CI 0.02-0.16; P < .001) after index examination or scheduling >6 months after order placement (OR, 0.35; 95% CI 0.14-0.87; P = .02); order placement by breast oncology or breast surgery departments (OR 0.35; 95% CI 0.17-0.73; P = .01) versus radiology department.

DISCUSSION

Incomplete BI-RADS 3 follow-up is associated with ultrasound or MRI, most socioeconomically disadvantaged patients, younger patients, Asian race, delayed order entry, and follow-up examination ordering and scheduling by non-radiology departments.

Radiology 2040

A translation of this article in Spanish is available in the supplement. Una traducción de este artículo en español está disponible en el suplemento.