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  1. Design of a privileging program for diagnostic imaging : Costs and implications for a large insurer in Massachusetts.

    Article - En anglais

    PURPOSE 

    To evaluate the results of a privileging program aimed to ensure that health care providers and facilities adhere to standards of care.

    MATERIALS AND METHODS 

    Technical and professional privileging applications were mailed to more than 1,800 diagnostic imaging facilities and more than 6,000 professional providers of services to members of a health care plan.

    Site inspections were used to determine whether facilities met standards of care.

    Specialty providers were assigned a range of current procedural terminology codes for which they had privileges to bill the payer.

    RESULTS 

    Of 1,004 imaging sites inspected, 197 (20%) failed with the ability to remedy the violation, 106 (10%) failed with fundamental and serious deficiencies, and 701 (70%) passed.

    Site inspection pass rates varied substantially by specially.

    Chiropractors and podiatrists were more likely to fail than medical and surgical specialists.

    A strong correlation was found between refusal to participate in the inspection and failure rate.

    Results suggest that reduction of the number of professional claims billed led to a 2% decline in total imaging expenditures, or a more than 10 : 1 return on the cost of implementing technical and professional privileging programs.

    CONCLUSION 

    Health care plans can positively influence costs and quality by developing, monitoring, and enforcing their own quality standards for diagnostic imagining.

    Mots-clés Pascal : Amélioration, Qualité, Diagnostic, Radiodiagnostic, Implémentation, Etude critique, Homme, Radiologie

    Mots-clés Pascal anglais : Improvement, Quality, Diagnosis, Radiodiagnosis, Implementation, Critical study, Human, Radiology

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 98-0387968

    Code Inist : 002B30A01C. Création : 25/01/1999.