Appropriate Use Criteria: Closing Gaps and Expanding Guidelines

Appropriate use is in the spotlight as the American College of Cardiology (ACC) seeks to close gaps and expand guidelines in response to an acceleration toward performance-based reimbursement models. Specifically, the first updates have been issued to the three-year-old coronary revascularization appropriate use criteria (AUC) to move the ACC closer to its goal of accurately monitoring and measuring appropriateness of cardiovascular procedures.

The guidelines have also been expanded in response to changes in medical evidence and calls for greater adherence to evidence-based medicine practices in the wake of highly publicized cases of inappropriate stent and implantable cardiac defibrillator use. Also at play were several studies that identified high rates of procedures that failed to meet appropriate use guidelines.

AUC Challenge: Data Integrity Issues

Documentation weaknesses and inconsistent data collection impact the integrity of the metrics against which appropriate use is measured. These barriers may limit efforts to fully utilize AUC to drive down costs and increase the quality of cardiovascular services by ensuring appropriate use and advancing the practice of evidence-based medicine.

Eliminating these obstacles has taken on greater urgency in the evolving reimbursement environment. Though AUC were explicitly not established for adjudicating payment, they are being used that way, albeit unofficially. Further, CMS and private payers are expected to eventually use AUC for development of reimbursement strategies.

ProVation® MD: Guides Thorough Documentation, Enhances Data Integrity

ProVation MD eliminates the barriers to effective appropriate use criteria by shoring up weaknesses in documenting procedures. By guiding thorough, fast procedure documentation, our industry-leading software overcomes both data quality and standardization issues.

  • The unparalleled DocuDiagram® provides a fast, graphical method to document cardiac findings
  • By flagging specific AUC data points to ensure they are not overlooked by the physician during documentation, reporting gaps are eliminated and standardization is assured
  • Critical data elements, required for ACC registry reporting, can be fed automatically to reporting tools for submission, streamlining workflow and protecting data integrity

By making AUC data requirements an integral part of a physician's documentation workflow,ProVation MD:

  • Increases the efficiency with which reporting is accomplished
  • Eliminates redundant data entry
  • Improves data quality and accuracy