According to a 2010 study by the Institute of Medicine, “unnecessary services” are the largest contributor to health care waste in the United States, accounting for approximately $210 billion of the estimated $750 billion in excess spending each year. Additionally, a 2014 survey of more than 2,100 physicians by the American Medical Association found that 20.6% of overall medical care was unnecessary, including 24.9% of tests, 22% of prescription medications and 11.1% of procedures.
Avoiding unnecessary services is not only the right thing to do for our patients’ health and safety, but it is also the smart thing to do for our system economically.
One of the tools available to SHMG providers that can help prevent unnecessary services is CareSelect clinical decision support (CDS). Originally implemented at Spectrum Health in 2018, CareSelect CDS is found within Epic and is used to evaluate the appropriateness of exams and imaging orders for high-cost radiology/cardiovascular advanced imaging studies (CT, MRI, NM, PET).
In February 2021, Spectrum Health upgraded the original CareSelect CDS software to an artificial intelligence version which has greatly improved its functionality and ease of use. After an imaging order is placed, the CareSelect CDS AI tool evaluates points such as the patient’s age, gender, problem list, provider specialty and diagnosis associated with the order, and provides a color-coded score of its appropriateness. After, providers are given an opportunity to keep the original order or change to a suggested order.
As of December 31, 2021, Spectrum Health’s compliance with CareSelect CDS use is 87.4%. Our goal is to reach 95% compliance by September 1, 2022. Once we achieve 90% compliance, we will be awarded Gold Card status from Priority Health. This status ensures that imaging orders for Priority Health patients would no longer require prior authorizations. Currently, Spectrum Health places a hold on scheduling all advanced imaging orders for a minimum of three days pending prior authorization. With Gold Card status, we will be able to schedule these services the same or following day after being submitted for review to eviCore.
Help our patients get the care they deserve when they deserve it by trying out CareSelect CDS in Epic. Tip sheets for clinical team members and providers are available now.
For questions on CareSelect CDS, contact Sam Mulliken.