Appropriate Use Criteria for Echocardiography in the Era of Value-Based Care: Mission Accomplished or Future Mandates?

Abstract

Purpose of Review The purpose of this review is to highlight the past impact and current role of the Appropriate Use Criteria (AUC) for echocardiography in value-based healthcare, and to address future implications in light of the recent mandate from the Centers for Medicare and Medicaid Services to incorporate AUC for other imaging modalities. Recent Findings Several studies have proven that the AUC effectively stratify the clinical practice of echocardiography as they predict important echo abnormalities and impact optimal patient care. Recent investigations have tested new technologies and demonstrated the feasibility and scalability of the application of the AUC for echocardiography at the point of care. Summary The AUC for echocardiography has accomplished their core mission, as utilization has moderated over the last decade and mandatory implementation at the point of care for echocardiography remains rare. While a new mandate signals another wave of focus on appropriate utilization, echocardiography stands ready.

Evaluation of Appropriate Use of Preoperative Echocardiography before Major Abdominal Surgery: A Retrospective Cohort Study

“…However, as the highest volume cardiac imaging test performed, resting echocardiography is expected to be included as the program expands. 21 Further, perioperative testing is likely to be a particular focus and may be disproportionally affected by these programs. Our study addresses the knowledge gap of appropriate use criteria for resting echocardiography on a national level, and our finding of a high frequency of rarely appropriate studies suggests significant potential overuse.…”

The Rate of Appropriate Adult Transthoracic Echocardiogram at King Abdulaziz University Hospital Based on Appropriate Use Criteria of 2011, 2017, and 2019

“…Initially, the AUC were published in 2007 and later updated in 2011 to "respond to the need for the rational use of imaging services in the delivery of high-quality care" [10]. Nearly, all TTEs performed in a wide variety of clinical settings have been judged depending on the AUC [11,12]. These criteria categorize indications for echocardiography as appropriate, inappropriate, or uncertain [11,12].…”

“…The aim of applying the appropriateness criteria involves improving patient outcomes, including survival and health status, as well as decreasing the number of unessential imaging studies [11,13]. An "appropriate (score of 7 to 9)," study is defined as an imaging study that is widely suitable as a reasonable approach for an indication, an "inappropriate (score of 1 to 3)."…”

“…Nearly, all TTEs performed in a wide variety of clinical settings have been judged depending on the AUC [ 11 , 12 ]. These criteria categorize indications for echocardiography as appropriate, inappropriate, or uncertain [ 11 , 12 ].…”

“…The aim of applying the appropriateness criteria involves improving patient outcomes, including survival and health status, as well as decreasing the number of unessential imaging studies [ 11 , 13 ]. An “appropriate (score of 7 to 9),” study is defined as an imaging study that is widely suitable as a reasonable approach for an indication, an “inappropriate (score of 1 to 3).” study is defined as generally not suitable and not reasonable, and a study is considered as “uncertain (score of 4 to 6),” if it is suitable or reasonable, however, more research or patient information is needed [ 14 , 15 ].…”