December 20, 2022

Diagnostics as a Defining Touchpoint in the Claims Journey

The timing of when specialized diagnostics tests (such as advanced imaging services like MRI and CT) should optimally occur following the onset of injury is an area where clinical approaches can vary.

Some providers take a “wait and see” approach, while others take the position that the sooner a patient is diagnosed, the sooner treatment and a plan for recovery can begin. In reality, the timing of specialized diagnostic testing can be a complex decision that includes individual patient considerations and multiple stakeholders.

Sometimes, speed matters: The ability for the treating physician to create a treatment plan that will effectively guide an injured worker back to health relies on establishing an accurate diagnosis. When the accuracy of that diagnosis in turn relies on findings from advanced imaging services, the efficiency in which these services are ordered and delivered can be important to getting the claim off on the right foot.

Potential Impacts of Delayed Diagnostics Services

  • Higher rates of missed appointments
  • Treatment delays
  • Exacerbation/worsening of injury
  • Increased lost-time days
  • Increased lengths of stay
  • Increased downstream costs

Delays in reviewing diagnostic test results have been associated with subsequent delays in medical care and negative outcomes such as prolonged hospital stay and costs. Longer periods of wait days (WDs) are also associated with a higher likelihood of missed appointments. A retrospective study of more than 40 thousand patients identified a correlation between WDs for scheduled MRI services and missed appointments – meaning that the longer the time period between when a test is ordered and the day of actual service, the more likely the patient will not show up.

Notably, this effect was more pronounced in underrepresented minority populations and patients of low socioeconomic status, signaling the role that timely service delivery can play in helping to address health inequity.

But the science on when the timing is right continues to evolve. “There are some newer and, in some cases, seemingly conflicting practices,” explains Healthesystems’ clinical expert Tate Rice, PT, DPT, MBA. “It used to be that you shouldn’t conduct an MRI too early because of the swelling. Now, we’re seeing data that says the swelling may actually help produce a better read.

Read the article in full online at RxInformer.

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