Reducing Errant Ordered Radiology Exams
Table 4. Change in HEDIS rates after MHV implementation.
Facility HeDIs screeNING rAtes mAY 2010
040 new/ N/A 5/10
HeDIs screeNING rAtes mAY 2012
HeDIs score Goal
The weather was a challenge from
both ends of the spectrum, as cold and
heat affect the coach differently. The
coach doesn’t do well on slick or icy
roads, so there was some rescheduling.
Low humidity triggers the environmental alarm system, necessitating late night
trips to add water to humidifiers. (With
low humidity, there is a risk of static electric, which could negatively impact the
images or the electronic chips in the machine.) A larger humidifier was installed
to decrease the necessity of going in over
a weekend to fill it; however, the larger
humidifier caused an increased amount
of precipitate dust, which tended to coat
the surfaces of the coach. It has been
challenging to get the humidity stabilized. High heat also causes the air conditioners to ice up.
The mobile mammography coach is
heavy ( 33,000 pounds). For parking purposes, there was no need to have a mobile
pad (ie, reinforced concrete), as the facility where it is parked overnight has a very
thick concrete base (it is a large warehouse
where the courier vans come and go). The
parking areas where services are provided
are all asphalt and can accommodate the
weight of the coach. The only problem
has been some very slight indents from
the leveling stabilizers on very hot days
(95+ degree). It is also very important to
map out routes to and from the screening
sites to ensure there is adequate height,
width, and weight clearance.
Medicare/Medicaid enrollment was
also a barrier. It is necessary to have
the coach and mammo equipment on
site and accredited before starting the
enrollment process. If enrollment approval is delayed, the MHV is not able
to perform mammograms on Medicare
patients, thus decreasing the efficiency of
Communication with the entire region was an issue; however, communication has been improved by developing
electronic communication methods (eg,
a website with the calendar for the coach,
which is accessible to any provider in the
region). Wireless connectivity has also
been difficult at times. Some locations
do not have as much coverage as others,
making connections difficult. Some of
this has been alleviated with workflows,
incorporating processes into the daily
The selection and purchase of an MHV
is a complex process utilizing a business
plan, RFI, a RFP, and a selection committee. The process of purchasing an MHV
for KFHP of Colorado took a little more
than 18 months. Colorado is not a CON
state and did not need to follow that
process. The MHV also includes digital
The primary reason for the business
plan’s approval was to improve the
mammography HEDIS penetration in the
Colorado region. At the time the business
plan was submitted, the breast screening
HEDIS rates were just over 78% (Table 4).
(The NCQA HEDIS mammography
benchmark at the end of 2010, was
74.94%.) At the end of May 2012, the rates
were just over 81% and, while not a huge
percentile increase, the trend is in the cor-
rect direction. The coach has been in op-
eration for less than a year, so it is probably
too soon to know if this upward trend will
continue. The mobile coach is also a large
moving billboard, seen by thousands each
day as it travels to and from screening
sites. The advertising impact is difficult to
measure, yet it should be factored into the
early success of the project.
1Sferrella SM, Allen ML, Reitter MS, eds.
Financial Management in Radiology. Sudbury, MA: AHRA; 2004.
2Foreman MS, Hubbard L, Marquez LO, eds.
Operations Management in Radiology. Sudbury, MA: AHRA; 2010.
Sheila Duvall is south area medical imaging manager
and mobile coach manager at Kaiser Foundation
Health Plan (KFHP) in Littleton, CO. She can be
contacted at Sheila. Duvall@kp.org.