July 21, 2017
A poster for the study “The Association Between Physician Intent to Perform Fractional Flow Reserve Measurement and Subsequent Percutaneous Coronary Intervention” was presented at AcademyHealth’s Annual Research Meeting (ARM) from June 25-27, 2017 in New Orleans, Louisiana.
The study’s lead author, Dr. Adam C. Powell, and his team sought to evaluate the impact of the response to a question on intent to perform fractional flow reserve (FFR) measurement, asked in the context of non-denial prior authorization for catheterization, on order and performance of percutaneous coronary interventions (PCI). Dr. Adam C. Powell and his team used 2015 administrative prior authorization data from individuals who had Medicare Advantage health plans from one health insurer. Since PCI procedures are sometimes conducted “ad hoc” based on findings during a diagnostic catheterization, ordering physicians are asked about their FFR measurement intent as part of the diagnostic catheterization prior to authorization process to ensure consideration of the test.
In observing the relationship between FFR measurement intent during catheterization ordering and PCI ordering, no association was found (global P = .21). Only 4.1 % of catheterization orders led to PCI orders within 30 days. 2,932 (22.8%) catheterization orders were followed by a claim. The association between intent to perform FFR and PCI claims was significant (global P < .0003). When ordering physicians indicated that FFR would not be performed, there was a subsequent PCI claim more than half the time.
Likelihood of a PCI order and PCI claim, by FFR intent was determined. Chi-square tests were conducted to evaluate whether a significant association exists between FFR intent and the likelihood of a PCI order or the likelihood of a PCI claim. No significant associate was found between FFR intent and subsequent PCI ordering. However, FFR intent was significantly associated with subsequent PCI claims. Catheterization orders specifying no intent to perform FFR measurement, without providing an explanation, were the most likely to result in downstream PCI claims. Catherization orders for which FFR is not planned without an explanation represent opportunities to improve the quality of care during prior authorization by determining why ordering physicians do not intent to perform an FFR study and encouraging the use of FFR, if applicable.
For more information on AcademyHealth’s 2017 Annual Research Meeting (ARM), visit http://www.academyhealth.org/events/2017-06/2017-annual-research-meeting.