Regence Launches Radiology Quality Initiative

Regence recognizes that in order to meet the increasingly complex health care needs of individuals, we need to constantly challenge ourselves to find ways to improve our programs. Effective June 1, 2009, Regence will begin a new clinical and quality review program for advanced diagnostic imaging performed in outpatient, non-emergent settings. Regence is partnering with American Imaging Management® (AIM®) to facilitate this program.

RQI is a safety, quality improvement, and utilization management program for expensive and potentially dangerous outpatient diagnostic imaging services. RQI will evaluate and direct the appropriate utilization of high technology diagnostic imaging services, achieving high-quality care, safety, and cost containment by:

• Promoting and guiding selection of the most efficient and cost-effective diagnostic imaging services
• Encouraging standardization of medical practice patterns and reducing variation in clinical evaluation
• Curtailing the performance of inappropriate diagnostic imaging studies
• Advocating bio-safety issues, including reduction of unnecessary radiation exposure
• Enhancing quality of health care for diagnostic imaging studies using evidence-based medicine and outcomes research from numerous resources
• Profiling providers on their adherence to evidence based criteria for use of imaging services

RQI is built on Regence clinical practice guidelines, Regence medical policy, and guidelines developed by American Imaging Management (AIM), our chosen partner for the program. The program consists of the following activities:

• Registration (Notification) – Physicians and other health care professionals who are ordering advanced diagnostic services (CT/CTA, MRI/MRA, Nuclear Cardiology, PET scans) are required to secure an imaging ID number through Regence vendor partner, AIM. The requests are reviewed, but no prior authorization is required. Registration facilitates profiling and reporting.
• Profiling/Reporting – Monitoring and reporting are used to track and identify inappropriate utilization and referral patterns. There is evidence that physicians modify utilization when given feedback. The feedback should include comparisons with peers and should be adjusted for factors affecting utilization (e.g., patient demographics, specialty, acuity, and severity).

Have Questions?

If you have questions about this new program, check out our Frequently Asked Questions (FAQ) for more information or contact your local Regence Sales contact.

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