General Help/Support
  General
  Q. What are Appropriate Use Criteria (AUC)?
  Q. What are Appropriate Use Criteria (AUC)?
A. Appropriate Use Criteria are ACC physician-developed standards describing various patient clinical presentations in which procedures may be considered. AUC are developed according to a rigorous methodology and have been tested in various settings [REFS].
  Q. What is FOCUS on Appropriate Care?
  Q. What is FOCUS on Appropriate Care?
A. FOCUS on Appropriate Care is the utilization and applications of AUCs to track and improve appropriate use of cardiac imaging and cardiac procedures through various tools and programs. The program partners with Clinical Decision Support (CDS) companies to deliver three primary components:
  • point-of-care decision support tool
  • quality improvement process
In addition, FOCUS on Appropriate Care tools and applications have been used as a Radiology Benefits Manager (RBM) alternative. FOCUS emphasizes the importance of collecting data on the appropriate use of cardiac imaging test prospectively as a part of the ordering process and then evaluating patterns of appropriate use over time to direct improvement.
  Q. Why has ACC developed FOCUS on Appropriate Care?
  Q. Why has ACC developed FOCUS on Appropriate Care?
A. ACC has developed FOCUS on Appropriate Care in recognition of the need for the profession to measure and improve appropriate use of cardiac imaging and procedures. It is a response to the members’ requests for a transparent, profession-led alternative to RBM’s.

Appropriate Use Criteria tools have NO hard denials and instead concentrates on providing tools for institutions to engage in a self-evaluation and performance improvement process. FOCUS tools and reports can help educate providers about appropriate use criteria patterns while aiding them in choosing the right test for each patient. The entire process is electronic and no phone calls or appeals are required. Documentation on average should take 30–90 seconds depending on the user’s vendor and platform that is selected.
  Q. How will FOCUS on Appropriate Care benefit my institution?
  Q. How will FOCUS on Appropriate Care benefit my institution?
A. FOCUS can remove the hassle of working with an RBM and allows providers to regain control of ordering tests for their patients. FOCUS also provides MOC Part IV credit and can be used to fulfill lab accreditation requirements related to appropriate use.
  Q. Can I give this tool to my primary care or hospitalists colleagues who would like to use the tool to decide what type of stress test to order?
  Q. Will consulting FOCUS on Appropriate Care tools and programs deny imaging test orders?
  Q. Will consulting FOCUS on Appropriate Care tools and programs deny imaging test orders?
A. No, there are NO hard denials in the FOCUS program only recommendations for care.
  Q. Do the AUC clearly define low, intermediate and high risk patients?
  Q. Do the AUC clearly define low, intermediate and high risk patients?
A. Risk is defined by a modified Framingham criterion (ATP III) for asymptomatic patients and Diamond and Forrester tables for symptomatic patients. Links to a Framingham risk calculator and the Diamond and Forrester tables are included in the module when these questions are presented.
 
  Getting Started
  Getting Started
  Q. Who is responsible for entering patient information for FOCUS on Appropriate Care?
  Q. Who is responsible for entering patient information for FOCUS on Appropriate Care?
A. AUC consulting programs are designed to be used at the point of care when a test order is placed; however, institutions should decide how the use of the tool best fits into their clinical workflow. Physicians, nurse practitioners, practice managers, or other staff may enter the data. Another option is to utilize one of our Clinical Decision Support Vendors who may be able to integrate directly into your Electronic Health Record, making AUC decision a seamless step in your ordering process.
  Q. How long will it take to enter patient information and receive an advice screen and unique decision support number?
  Q. How long will it take to enter patient information and receive an advice screen and unique decision support number?
A. FOCUS on Appropriate Care program has been designed to take 30-90 seconds to enter patient information, select a test, review an advice screen indicating an appropriate, inappropriate or uncertain rating, and generate a decision support number. Another option is to utilize one of our Clinical Decision Support Vendors who may be able to integrate directly into your Electronic Health Record, making AUC decision a seamless step in your ordering process.
  Q. Will training be provided?
  Q. Will training be provided?
A. ACC’s technology partners will provide various forms of training including: Webinars, tutorials, and other customer support to answer any questions. FOCUS on Appropriate Use utilization is designed to be very user friendly and require minimal training.

What are the other benefits of utilizing the information developed by FOCUS on Appropriate Use? Providers can use FOCUS on Appropriate Care programs for International Accreditation Commission Nuclear/PET accreditation ICANL and can also receive Maintenance of Certification (MOC ) Part IV credit.
  Q. How are health care providers using the AUCs in practice or improvement tools?
  Q. How are health care providers using the AUCs in practice or improvement tools?
A. Many practices are using nurses, lab technicians, and quality improvement staff to enter the data. Physicians also may choose to use the tool to help guide their ordering, although the improvement module is not designed for this purpose. In addition, many practices are reviewing a calendar month of orders retrospectively while others are entering cases in batches prospectively. The decision largely depends upon the data available in your practice to complete the case forms retrospectively. Either is acceptable. Some practices are also entering data to assess the appropriateness of orders coming into their laboratory, and therefore, entering data by interpreting physician. Other practices are entering data to assess the appropriateness of orders placed by their physicians. Either is acceptable if it is consistent across your practice.
  Q. Who owns the data collected?
  Q. Who owns the data collected?
A. Institutions will own their own data
  Q. How will ACC and its technology partners address gaming?
  Q. How will ACC and its technology partners address gaming?
A. ACC develops our connect based on patient risk models and verifiable data points. The analysis of gaming is addressed by our vendors in their own unique way.
  Q. What if my Rarely Appropriate rate is already low?
  Q. What if my Rarely Appropriate rate is already low?
A. The purpose of AUCs is not to drive the Rarely Appropriate rate to zero; some patient cases will present an exception to the AUC standards. The FOCUS on Appropriate Use tools allows for documentation of these exceptions. Exception documentation will not remove a case from the Rarely Appropriate rate. ACC is always open to feedback on the refinement and modifications of indications to make sure they are still clinically applicable. .
 
  Payment/Cost
  Payment/Cost
  Q. Will FOCUS cost my institution money?
  Q. Will FOCUS cost my institution money?
A. ACC does not charge for the use of the FOCUS App. The vendors who license the ACC AUC content are free to contract with hospitals and practices.
  Q. Is FOCUS linked to payment of imaging claims by health plans?
  Q. Is FOCUS linked to payment of imaging claims by health plans?
A. Yes. Centers for Medicare and Medicaid (CMS) passed the PAMA act (link) in 2014 that included a provision requiring ordering professionals to consult with appropriate use criteria (AUC) through a clinical decision support (CDS) mechanism for all Medicare patients receiving advanced imaging (cardiac nuclear, CT, MR).

If your site utilizes private insurance companies that is implementing AUC consulting, then FOCUS on Appropriate Care program through its technology partners, will be happy to work with your site to implement the use of AUC for private insurance payments.

Payment is NOT contingent upon the classification of the patient case. Payment only requires use of the documented consultation of AUC and does not depend on how the institution uses the advice provided by the FOCUS on Appropriate Use program.
  Q. How can my practice start preparing for the CDS mandate?
  Q. How can my practice start preparing for the CDS mandate?
A. The ACC offers several tools for practices to start benchmarking AUC adherence for cardiac imaging. FOCUS currently offers three options for AUC access for non-commercial practice improvement purposes.
  1. FOCUS Lab Accreditation Module: Chart review performance improvement module
  2. FOCUS Decision Support Software for Hospitals: Subscription based through CDS vendors
  3. FOCUS iPad Decision Support Tool: Free, algorithm based case review form
We are awaiting regulations from CMS to determine which AUC and CDS mechanisms will be approved for the program. In the meantime, we encourage practices to start reviewing these resources to determine whether the FOCUS on Appropriate Care tools or another mechanism will be best suited for use of ACC’s AUC as part of your delivery of care.
 
  CMD Mandate to Use Appropriate Use Criteria For Imaging Study Reimbursement
  CMD Mandate to Use Appropriate Use Criteria For Imaging Study Reimbursement
  Q. Will the ACC be exclusively licensing its content to a single vendor will there be a free tool?
  Q. Will the ACC be exclusively licensing its content to a single vendor will there be a free tool?
A. No, the ACC will offer licensing terms to any Clinical Decision Support (CDS) vendor agreeing to meet the standardized terms of the ACC’s AUC licensing agreement.

The ACC is working with CDS vendors to ensure its content is available in the free CDS tool once CMS determines the mechanism for this tool.

Please find the list of ACC vendors here and be sure to check back regularly as new vendors are being added regularly.
  Q. Will ACC lose control of the AUC if it licenses the content to several CDS vendors?
  Q. Will ACC lose control of the AUC if it licenses the content to several CDS vendors?
A. No, the intent is to maintain standards for implementation across all CDS Licensees while allowing the market to innovate in how the content is integrated and delivered to end users.
  Q. How will this impact clinical workflow for ordering tests? How long will this take?
  Q. How will this impact clinical workflow for ordering tests? How long will this take?
A. CDS is designed to match your clinical rationale and documentation for ordering. It generally requires standardizing what you already have provided for billing documentation. The total interaction is designed to be between 30 and 90 seconds. Practices and hospitals will likely choose between implementing this documentation at the time of order by the provider or at the time of scheduling the test with back office staff.
  Q. How will this function operationally for billing?
  Q. How will this function operationally for billing?
A.The documentation for Medicare billing is still to be determined, although the legislation requires that the CDS vendor, AUC score, clinical indication, procedure and decision support number all be communicated as a part of the required documentation along with provider NPI numbers. The goal is for CDS vendors to work with CMS to facilitate this documentation process, including verifying CDS was used prior to scheduling a patient for a test.
  Q. Who will own the data collected by the CDS vendors who have licensed the ACC AUC content?
  Q. Who will own the data collected by the CDS vendors who have licensed the ACC AUC content?
  Q. What is the status of the partnership between ACC and Medicalis?
  Q. What is the status of the partnership between ACC and Medicalis?
A. The ACC has partnered with Medicalis since 2011 to deliver an alternative to prior authorization for health plans through the FOCUS co-marketed health plan product. The College intends to continue to offer this health plan product with Medicalis while working with CDS Licensees to make ACC AUC content directly available to health care providers through their various technology platforms.
  Q. Will cardiac imaging appropriate use be determined ACCs content or by other AUC products and/or criteria?
  Q. Will cardiac imaging appropriate use be determined ACCs content or by other AUC products and/or criteria?
A. CMS will determine the content sets eligible for use to meet the mandate. The ACC was accepted as a qualified AUC content vendor to ensure our members are judged using ACC’s widely accepted AUC.
 
  Quality Improvement
  Quality Improvement
  Q. My organization needs to an AUC quality audit, Can ACC assist with this?
  Q. My organization needs to an AUC quality audit, Can ACC assist with this?
A. ACC offers two free options to complete a quality audit. The FOCUS APP allows clinicians to review individual cases, and it is up to the user to document the parameters and AUC result. We also provide an audit tool through the Performance Improvement Module (PIM) (link to PIM Questions), that allows clinicians to enter a small percentage of their patients and print of the results of the AUC ratings.
About the Performance Improvement Module (PIM)

  Q. What is a Performance Improvement Module (PIM)
  Q. What is a Performance Improvement Module (PIM)
A. Providers whose inappropriate rate falls below a level that and acceptable. These providers may use the FOCUS PIM to develop and implement an action plan for improvement.

The primary responsibility for an institution will be to complete a review of their performance, identify targets for improvement and complete a web questionnaire to assess their institution’s readiness, action plan, and results.
  Q. What exactly does the improvement tool do?
  Q. What exactly does the improvement tool do?
A. The modules are web-based tools that guide physicians through the collection of patient data on appropriate use to identify performance gaps and ultimately implement a quality improvement plan for their practice.
  Q. Do I need to use the improvement tools to participate in FOCUS program?
  Q. Do I need to use the improvement tools to participate in FOCUS program?
A.No, the improvement tools are optional. While they are excellent tools for determining and tracking your appropriate use rating, if you already have a tracking process in place the ACC tools may be redundant. Please share how yours is working!
Using the PIM

  Q. What do I need to begin using the PIM?
  Q. What do I need to begin using the PIM?
Participants just need a free ACC.org account to use the PIM.
  Q. Why does the PIM require a tax identification number?
  Q. Why does the PIM require a tax identification number?
Tax ID numbers are used only to compare participants with others who share their tax ID numbers.
  Q. Who can help me if I have a technical question or have a user error (like hitting submit too soon?
  Q. Who can help me if I have a technical question or have a user error (like hitting submit too soon?
Contact focus@acc.org for assistance with details of the question or issue. If you accidently hit the submit button and need to continue entering patients in stage 1 please be sure to include your name and email address.
  Q. Is it OK to enter a few fictitious patients just to learn how to use the tool?
  Q. What if I am unsure about how to categorize or enter patients?
  Q. What if I am unsure about how to categorize or enter patients?
A. If you are a non-clinical employee or don’t know which category to classify your patients under, go with the most recent prior procedure/symptoms. If it is still unclear refer to ACC’s Appropriate Use Criteria document for that specified test.
  Q. Can I enter data at different times or does it have to be all at once?
  Q. What if I am unsure about how to categorize or enter patients?
A. If you are a non-clinical employee or don’t know which category to classify your patients under, go with the most recent prior procedure/symptoms. If it is still unclear refer to ACC’s Appropriate Use Criteria document for that specified test.
  Q. Can I go through the PIM more than once?
  Q. Can I go through the PIM more than once?
A. Yes, however each account requires a unique email address therefore to go through the PIM multiple times. You will have to register again with a different email.

It is not possible to wipe the account clean after a participant has been through the PIM once.
  Q. What questions (data points) are requested for each perfusion study entered/Where can I find the paper data form participants can use to collect patient information?
Using the PIM for ABIM MOC IV credit

  Q. How do I claim my American Board of Internal Medicine (ABIM) credit?
  Q. How do I claim my American Board of Internal Medicine (ABIM) credit?
A. To claim credit you must go through the ABIM website.
Using the PIM for Intersocietal Accreditation Commission Nuclear Cardiology Accredited Laboratory (INCL) Accreditation

  Q. What are the requirements for iCANL accreditation?
  Q. What are the requirements for iCANL accreditation?
A. As part of the ICANL accreditation process, quality improvement measures including appropriate use must be measured at least once during the accreditation period. Labs are required to measure appropriate use in consecutive patients (e.g. 2-3-week period) to equal 5 percent of their annual volume of cardiac radionuclide imaging studies. The total number of patient cases entered must equal 5 percent NOT the number of cases entered in each individual stage.
  Q. How many cases do I need to enter?
  Q. How many cases do I need to enter?
A. If you are doing this for ICANL you need to enter 5 percent of your total case volume.

The minimum is 10 cases but we strongly encourage entering at least 30 patients in each stage to get a more accurate picture of your practice patterns.
  Q. Who are my AUC rates compared to at the end of the first stage?
  Q. Who are my AUC rates compared to at the end of the first stage?
A."My rate": Your AUC rate based on the patient cases you entered “My specialty rate”: AUC rate of all others who classified themselves under the same specialty “My practice rate”: AUC rate of all participants under the same tax ID number
 
  Vendor List
  Vendor List

ACC as a Qualified Provider Led Entity (QPLE) we are dedicated to working with every Clinical Decision Support organization what wants to license our content. All of our vendors offer multiple methods for CDS including but not limited to web portal options, EHR app plug ins to EHR integration. Please visit each vendor to determine which option is best for you.

Our current vendors are: