Presentation: Implementing AUC for Diagnostic Imaging Services

This presentation outlines the Appropriate Use Criteria (AUC) project for diagnostic imaging services, a critical initiative stemming from the Protecting Access to Medicare Act (PAMA) of 2014. The project aims to enhance the appropriateness of advanced diagnostic imaging services provided to Medicare beneficiaries by requiring ordering providers to consult qualified clinical decision support mechanisms (CDSM). The presentation covers the project's background, objectives, scope, desired outcomes, assumptions, and constraints. It details the project's objectives, including the enhancement of advanced diagnostic imaging services and the implementation of technology and business processes to support CDSM utilization. The project scope encompasses funding, resource allocation, CDSM consultation, and post-project review. The desired outcomes emphasize the importance of imaging services in the diagnostic world. The presentation also addresses project assumptions, constraints such as risks of claim denial and penalties, and risk, communication, quality, scope, and schedule management strategies. It concludes by referencing relevant research and project management frameworks to support the project's implementation and success.

Appropriate Use Criteria (AUC) for
Diagnostic Imaging Services

Project overview
• The focus in on AUC for proper diagnostic
imaging services.
• The AUC program was mainly a part of PAMA
(protecting Access to Medicare Act) of 2014.
• It aims to enhance the importance of diagnostic
imaging services which will be given to the
Medicare beneficiaries.

Background
• The AUC program which is found to be the part of Protecting
Access to Medicare Act in the year 2014 (PAMA).
• The program is arranged for properly enhance the
appropriateness for advanced diagnostic based imaging
services
• It is found that this generally needs the ordering providers to
properly consult with qualified clinical CDSM.
• Furthermore, Medicare helps in claiming that advanced
diagnostic imaging generally includes proper evidence of the
CDSM consultation

Project objective
The objectives are:
• To enhance the use of advanced diagnostic
imaging services
• To implement both technology as well as
business processes for supporting the
utilization of CDSM tools
• Use of advanced imaging services helps in
meeting the requirements and for avoiding
the issue of penalties.

Project scope
The project scope mainly includes:
• Identifying ways for getting funding
• Allocating time and resources within the project
• Making arrangement for the program
• Determining the resources and equipment’s which are needed
• Getting consultation with CDSM
• Use of electronic portals
• Use of Computed technology, nuclear medicine as well as magnetic resonance imaging
• Post project review and stakeholder sign off

Desired outcome and success criteria
If the following criteria’s will be achieved by the
project manager within the project then the project can
be considered to be successful:
• If the work of the program that aims to arrange AUC
program for reflecting the significance of imaging
services in diagnostic world then the project is
mainly considered to be successful.
• If the appropriateness as well as importance of
imaging services are increased then the project can
be considered to be successful.

Assumption
The project assumptions include:
• The project manager assumes that the program that
focuses on showing the appropriateness of imaging
services will get completed on assumed budget and time.
• It is analyzed by the manager that the business procedure
will be developed after making proper consultation with
CDSM.
• The project manager also assumes that the technology as
well as business procedure that are developed not only
helps in resolving problems of penalties

Constraints
The various constraints are elaborated below:
• It is found that risks related with claims denial as
well as non-compliance related penalties
generally starts on January 2021 and this can
create a lot of economic issues
• If the program does not get completed within 9
months of time then the problem of schedule
slippage occurs

Risk management
Risk Impact Probability Mitigation
Schedule slippage: The schedule that
is developed if not properly tracked
then the schedule face slippage and
therefore delay can occur.
High High The issue of delay can be avoided by
focussing on the schedule so that the
work of the project can be tracked
effectively and if any type of delay
occurs, it can be managed instantly.
Budget shortfall: The budget that is
allocated is not enough for finishing
the project then the problem od
budget shortfall can occur that can
cause financial issues.
High High The budget that is needed must be
estimated accurately by analyzing the
market prices so correct amount of
money will be allocated for finishing
the work of the project.

Risk management Contd.
Risk Impact Probability Mitigation
Improper implementation: If proper
implementation of technology and business
process are not implemented properly then
the requirements will not meet and the issue
of penalties will exist.
Medium Medium It is necessary to focus on proper
implementation of business process and
technology so that the proper requirements can
be made and the issue of penalties can be
avoided.
Scope creep: Instant changes within the
program will cause scope creep and due to
all this, the program will face delay.
Medium Medium For managing such issues and for avoiding the
problem of scope creep, it is quite important to
follow proper procedure while making changes
within the program so that only the required
changes will be added after analyzing its
significance on the program.

Communication management
• Proper communication plan must be developed
in the initial steps by elaborating the ways with
which communication will took place
• Meetings must be held for AUC program for
reflecting the issues that the team members and
supervisors faces while conducting the program
so that such issues can be resolved effectively.

Quality management
In order to manage the quality of the program, the following steps needed to be
taken and the steps are elaborated below:
• In the initial step, it is necessary to properly define the needs of the program as
well as program stakeholders
• In planning phase, it is quite important to properly determine as well as manage
the quality by using proper tools and techniques within the program.
• It is necessary to conduct inspections as well as tests periodically within the
lifecycle of the project
• The time that which will be spend on quality management must be dependent on
the size as well as complexity of the undertaken project.

Scope management
For proper scope management, the steps which are undertaken
are elaborated below:
• Proper planning is made for including information about the
scope and for reflecting ways which are used for handling
unforeseen circumstances within the project for keeping
project on track.
• All the requirements which are needed for executing the
program are collected for avoiding hurdles during the
progress of the program
• It is important to broke the project into smaller individual
tasks so that those tasks can be executed properly.

Schedule management
The steps that are needed to be taken for managing
schedule are reflected below:
• Planning schedule management:
• Sequencing activities
• Tracking schedule

Timeframe

Project budget
Items Cost
Materials $10k
Human resources $20k
Equipment’s $30k
Planning cost $5k
Additional cost $5k
License cost $60K
Ongoing maintenance $84.6 k
Total cost 214.6 k

References
• Rosman, D. A., Duszak Jr, R., Wang, W., Hughes, D. R., & Rosenkrantz, A. B. (2018).
Changing utilization of noninvasive diagnostic imaging over 2 decades: an examination
family–focused analysis of medicare claims using the Neiman imaging types of service
categorization system. American Journal of Roentgenology, 210(2), 364-368.
• Jossen, M., Valeri, F., Heilmaier, C., & Schwappach, D. (2019, August). Referring
Physicians Assess the Quality of Outpatient Diagnostic Imaging Services: Development and
Psychometric Evaluation of a Questionnaire. In RöFo-Fortschritte auf dem Gebiet der
Röntgenstrahlen und der bildgebenden Verfahren (Vol. 191, No. 08, pp. 725-731). © Georg
Thieme Verlag KG.
• Guermazi, A., Hayashi, D., Jarraya, M., Crema, M. D., Bahr, R., Roemer, F. W., ... & Skaf,
A. (2018). Sports injuries at the Rio de Janeiro 2016 Summer Olympics: use of diagnostic
imaging services. Radiology, 287(3), 922-932.

References Contd.
• Kerzner, H. (2017). Project management: a systems approach to planning, scheduling,
and controlling. John Wiley & Sons.
• Kerzner, H. (2019). Using the project management maturity model: strategic planning for
project management. John Wiley & Sons.
• Carvalho, M. M., & Rabechini Jr, R. (2017). Can project sustainability management
impact project success? An empirical study applying a contingent approach. International
Journal of Project Management, 35(6), 1120-1132.
• Muriana, C., & Vizzini, G. (2017). Project risk management: A deterministic quantitative
technique for assessment and mitigation. International Journal of Project
Management, 35(3), 320-340.