Care to Care's RBM Programs Treat Referring Physicians as Partners in Promoting Better Patient Care
New modalities in imaging have been developed so rapidly that it is impossible for physicians in other specialties to keep abreast of which studies are likeliest to be of value, and which have been rendered obsolete, or shown to be marginal in answering a particular clinical question. A good RBM program has to begin with an understanding of the pressures faced by referring doctors, their professionalism and skills if it is to be more than another annoyance disguised as a utilization management device.
All RBMs doing prior authorization require clinical information for each request, and compare what is received to a set of clinical criteria. Our approach was designed to identify questionable requests as rapidly as possible, and to have them reviewed by one of our board certified radiologists right away. All of our physician reviewers are radiologists. No criteria set -- even ours -- can cover all foreseeable clinical situations, so having experienced radiologists involved in the prior authorization process is an advantage that allows us to clear roughly half of the cases that do not get approved at the intake level without demanding anything more from the referring doctor.
Just as important is how we deal with those cases that do not meet criteria and are not approved by our radiologist physician reviewers.
Our approach sets our approach apart. No request is ever denied without offering the referring doctor a chance to discuss the case directly with one of our radiologists. We believe that this is an indication of our respect for their judgment. By employing radiologists exclusively for this role we increase the credibility of our positions, as these are truly peer-to-peer discussions. Not only are these conversations an opportunity for us to explain why a particular request was not clinically appropriate, given the information we received, but we may also learn of other facts sufficient to allow approval. The collegial tone we foster makes it likelier that the referring doctor will accept a
Notices
About Dr. Michael Komarow
Chief Medical Officer
Dr. Komarow is a radiology benefits management industry veteran. He has supervised the compiling of Care to Care's evidence-based criteria to promote the appropriate use of diagnostic imaging. He is a graduate of the Medical College of Virginia Commonwealth University where he received his MD. After completing residency training at the Robert Packer Hospital in Pennsylvania, he became board certified in radiology. Dr. Komarow practiced for 21 years as a staff and chief radiologist at the Kingston Hospital (New York) where he chaired several medical staff committees. He is the former Chief Medical Officer of one of the largest RBM companies, and has worked with Care to Care since 2008. Dr. Komarow served in the Medical Corps of the US Army Reserve for 10 years, received his law degree from Pace University Law School in 1995 and is a member of the New York Bar.
