1. E-QUAL Avoidable Imaging Kick Off
Rural Avoidable Imaging

2. E-QUAL Emergency Quality Network
National quality movement, supported by CMS
Enrolling over 24,000 Emergency clinicians over the next 4 years to participate in quality improvement activities focused on:
Improving outcomes for patients with sepsis
Reducing avoidable imaging in low risk patients by implementation of ACEP’s Choosing Wisely recommendations
Improving the value of ED evaluation for low risk chest pain by reducing avoidable testing and admissions
What is EQUAL

3. We have enrolled in E-QUAL
Our next quality improvement project is on Reducing Avoidable Imaging
Our plan:
Utilize E-QUAL resources to:
Reduce avoidable imaging + report our data
= meet CMS requirements
= increase our revenue!

4. Why did we join E-QUAL?
To improve our ability to reduce low-value imaging and to increase our revenue
Meet CMS requirements
E-QUAL initiatives are aligned with CMS hospital quality reporting and payment initiatives
Improve revenue
Improve patient outcomes
Rural-specific resources and support
Best practices, rural considerations, implementation assistance
Reduction in liability through standardization
CME & MOC credits

5. E-QUAL and MOC Part IV Credit
E-QUAL will be listed on the ABEM drop down list of opportunities
ED Director will need to be listed attesting that the individual participated in E-QUAL.
E-QUAL hopes to develop “automatic” credit soon
E-QUAL and CME Credit
All E-QUAL webinars/podcasts will be associated with eCME credit.
To obtain credit visit the E-QUAL homepage

6. Why are we quality reporting?
There is a new Medicare physician reimbursement program – links quality to reimbursement
This is the Merit-based Incentive Payment System (MIPS)
Concept behind MIPS
High quality care + data reporting
= better MIPS performance
= larger Medicare reimbursement

7. MIPS Merit-based Incentive Payment System
New Medicare reimbursement program that links quality and data reporting to reimbursement
Medicare reimbursement
Automatic reimbursement increases from
After 2019, reimbursement will be based on our performance under MIPS
MIPS has two categories for measuring the performance of Emergency clinicians
Quality
Sepsis care is one of the quality measures
Clinical Practice Improvement Activities (CPIA)
E-QUAL is likely a high-value CPIA
E-QUAL is considered an activity for CPIA

8. Avoidable Imaging Goal: Choosing Wisely:
To reduce testing and imaging with low risk patients through the implementation of EM specific Choosing Wisely Recommendations
Choosing Wisely:
Initiative of the ABIM Foundation and Consumer Reports
Aim to advance national dialogue on avoiding unnecessary tests, treatments, procedures
Identified “Top 5” list from nine specialty societies

9. What are the targets for avoidable imaging?
Reduce use of high-cost imaging for low back pain
Reduce head CT scan after minor head injury
Reduce head CT scan after syncope
Reduce chest CT for pulmonary embolus
Reduce abdominal CT for renal colic

10. Current state of avoidable imaging
Advanced imaging (CT, MRI) have been identified as areas of overuse
Implementation of utilization management tools (clinical decision rules) are linked to a reduction in avoidable imaging
Example: Pulmonary Embolism (PE) & CT use
1/3 of imaging performed for suspect PE can be categorized as avoidable
Application of Wells Criteria and PERC rule can reduce avoidable CT use in assessing for PE

11. What will we gain from E-QUAL’s avoidable imaging rural series?
Guidelines and Materials
From Choosing Wisely, ACEP, PECARN
Educational Resources and Lectures for CME
Update on most recent Imaging literature
Data collection tools
Patient Engagement materials
Webinar/Podcast series
Initiation & implementation of avoidable imaging initiatives

12. What Interventions Could We Implement to Improve Care?
Implementation of a standard diagnostic algorithms for several of these conditions
Pulmonary embolism & CTs
Wells Criteria and PERC rule for PECT
Head injury & CTs
PERCARN rule for pediatric head trauma
New Orleans Head Injury rule for adult head trauma
Low-radiation, low-resource alternative modality
Use of Ultrasound instead of CT for renal colic
Leverage CEDR and E-QUAL data analytics tools to provide feedback to providers