The DIR is an excellent way for radiologists to obtain several MIPS Quality Measures. However, typically the DIR setup and maintenance tasks are handled by someone at the facility. Unfortunately, many facilities struggle to understand and/or use the DIR appropriately. It is certainly not a set and forget project: It takes regular maintenance, e.g,. monitoring, quality checking, mapping reviews, etc. The risk for the radiologists is that if the DIR is not maintained properly, the DIR results used by CMS to calculate your quality score could indicate the facility is imparting higher than normal doses, which may impact the radiologists' actual quality score when CMS starts using their dose comparisons to calculate it. In my opinion, someone representing the radiologists should at a minimum, keep marginally apprised of how the facility is maintaining the DIR, if not be an active participant in it.
In my experience, many CT staff are not given the time necessary to develop the level of understanding necessary to use the DIR properly, let alone to maintain it. Too often one person sets it up, then the responsibility is reassigned to someone new who must then try to come up to speed. Sometimes it is simply never adequately reviewed. The DIR is not difficult, but it does require some caretaking. The importance of the initial mapping, and then regularly rechecking and revising the mappings, is often overlooked. Mistakes and mis-mapping occur for many reasons. For example, let's say Multi-phase CT scans of the Abdomen/Pelvis w/ contrast are mapped to a CT scan Abd/Pelvis w/ contrast RPID. This is a common mistake. Multi-phase CT scans impart far higher doses that single phase CT scans impart. If multii-phase CT scans are routinely performed, this will push the facility's doses for CT scan of the Abdomen w/ contrast above the 75th percentile, potentially lowering their quality score when, in fact, it was simply due to mis-mapping. CMS will have no way to know.
I am giving a webinar "Using the DIR to Implement an Effective and TJC Compliant Dose Monitoring Program" Thursday, June 14 at Noon as part of a regular speaker series sponsored by Cassling Diagnostic Imaging. It is free and the session is approved for 1.0 CE credit from the American Society of Radiologic Technologists. This is an updated version of what I gave at an RBMA meeting two years ago. Click on the webinar title above for more information and a link to the registration page.
Feel free to attend. Perhaps more importantly, you may want to share this with your hospital counterpart.
Michael Bohl
Dose Registry Support Services
563.650.4606
mbohl@doseregistry.com
www.doseregistry.com
Bohl Radiologic Technologist Scholarship Fund
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