MGI produces appropriate use criteria (AUC) to address nearly all commonly seen clinical scenarios, making the criteria both more effective and more user-friendly in the clinical setting. The development process focuses on identifying the imaging procedures that would be most appropriate and timely at particular points in diagnostic and treatment cycles. They are not intended to supersede or replace sound physician medical judgment, but to support it.
MGI AUC are built on a foundation of nationally accepted imaging recommendations from professional medical societies, evidence-based clinical data and published medical literature from peer-reviewed journals.
Additionally, MGI’s Autonomous Multidisciplinary Team members review new applications of existing diagnostic imaging modalities and emerging new modalities throughout the year to determine whether and when they are appropriate for use. To meet that standard, these applications or modalities must have demonstrated effectiveness and practicality as diagnostic tools for the current acceptable practice of medicine. If judged to be appropriate, these new applications or modalities are included in MGI AUC.
MGI's Autonomous Multidisciplinary Team members also track trends, research clinical literature and attend applicable conferences to ensure that they are well-informed regarding potential industry changes that would require AUC revisions.
MGI AUC are designed to be instructional, educational and useful in open exchanges with referring physicians. Criteria and published references are readily available to referring physicians, rendering facilities and beneficiaries.
MGI’s AUC development process
1. organization of the Autonomous Multidisciplinary Team
The MGI Autonomous Multidisciplinary Team is comprised of providers from various specialties who have served as leaders and decision-makers for the AUC development process. They are responsible for managing the overall process and choosing Clinical Topic Section Leaders from among the group.
2. Designation of Clinical Topic Section Leaders And subgroup Support teams
Clinical Topic Section Leaders have been designated for each AUC section (e.g., Cardiac Imaging Guidelines, Chest Imaging Guidelines, Head Imaging Guidelines, etc.). Because MGI criteria cover nearly all clinical scenarios, Clinical Topic Section Leaders have appropriate specialty expertise. From the broader Autonomous Multidisciplinary Team, the Clinical Topic Section Leaders are assigned a support team of clinical experts and research resources, which form a subgroup that facilitates the AUC development process. Every one of MGI’s subgroups supporting an AUC section meets the standard for an Autonomous Multidisciplinary Team on its own.
3. Review and Gather Information
MGI Section Leaders and their subgroup support teams perform literature reviews, as well as gather and analyze clinical data. They use evidence-based clinical data (to the extent that it is available), statements from specialty societies, and published literature in peer-reviewed journals. Various clinical specialty societies’ current guidelines have been used to compare with new MGI guidelines. (See representative list of specialty societies at the end of this section.) Peer-reviewed literature is rated using the American Association of Family Practice (AAFP) level of evidence scheme.
4. Draft AUC
MGI Clinical Topics Section Leaders oversee the development of the AUC by their subgroup support teams using information gleaned from the reviewing and gathering exercise in Step 3. It should be noted that these AUC are designed to ensure that each patient receives the most appropriate diagnostic testing to meet his or her needs. To accomplish this, criteria are organized according to the patients’ clinical presentation or known disease processes rather than the imaging modality that is to be used. This is very different from other criteria that may be merely a list of indications for a particular imaging modality. The MGI approach is modeled after that used by treating physicians when they are performing clinical assessments and, as such, is more logical and acceptable to those treating physicians. Published references used in developing the AUC are included in each section.
5. AUC Review
The full Autonomous Multidisciplinary Team reviews and comments on all draft guidelines developed by the Clinical Topic Section Leaders and their subgroup support teams. Any modifications or discussions about AUC takes place during these reviews. The AUC are then approved by the full Autonomous Multidisciplinary Team.
6. Annual Review
In addition to the ongoing review process that occurs throughout the year, MGI’s Autonomous Multidisciplinary Team formally reviews the AUC annually through the process described above. These annual reviews are comprehensive, covering all Clinical Topics, including new and revised AUC that were approved during the year. Reference articles and other supporting source materials are re-verified for continued relevance and possible superseding information. Overall, changes will be made based on new evidence, medical society recommendations, AMA CPT Code updates and Medicare updates.
Leading medical specialty organizations
MGI AUC is in keeping with best medical practices as supported by domestic and international research, which is published in the appropriate peer-reviewed medical literature. In addition, the criteria incorporates consensus/guideline statements from leading medical specialty organizations, including:
- American College of Cardiology
- American Heart Association
- American Society of Nuclear Cardiology
- American College of Radiology
- American Academy of Neurology
- American College of Chest Physicians
- American College of Rheumatology
- American Urological Association
- National Comprehensive Cancer Network
- American Society of Clinical Oncology
- American Society of Colon and Rectal Surgeons
- Institute for Clinical Systems Improvement
- American Academy of Orthopedic Surgeons