Refer Wisely

Refer Wisely

Helping primary care providers make better use of myocardial perfusion imaging.

Refer Wisely™ is a joint initiative of the American Society of Nuclear Cardiology and the American College of Physicians to provide education regarding the Appropriate Use of Diagnostic Imaging with a specific focus on the appropriate use of myocardial perfusion imaging. The goal of the Refer Wisely program is to assist physicians in making wise referral decisions. The educational outreach involves both live and online programs, developed by a Steering Committee, to address the clinical challenges facing referring physicians in making an appropriate testing decision for patients with known or suspected coronary artery disease and will serve as a resource for decisionit's role in providing value.


The ReferWisely™ Interview series addresses important issues facing primary care physicians caring for cardiac patients. These best practice approach to clinical decisions and issues of health policy will provide an important dimension to the educational materials of this ReferWisely™ initiative. 

Introduction to Appropriate Use
Drs. David Wolinsky and Larry Phillips discuss the value of testing and what the test should accomplish. The role of cardiac testing in today’s healthcare environment is changing and primary care physicians need a firm understanding how diagnostic imaging impacts patient management. Understanding the evolution of Appropriate Use Criteria and the need for incorporating these concepts into clinical practice is an important part of providing effective patient care.

PAMA (Protecting Access to Medicare Act)
Drs. David Winchester and Rami Doukky discuss the development of Appropriate Use Criteria and their impact on ordering advanced imaging studies (nuclear, cardiac CT and cardiac MR). The discussants also explore the impact of the PAMA mandate to adopt AUC for Medicare reimbursement and the role that AUC may play in other quality payment programs, such as MACRA.

Appropriate Use Poster

Management and Testing of Ischemic Heart Disease:
Developed by Dr. David Winchester and edited by Dr. Andria Medina this poster provides an easy-to-use reference on the Appropriate Use Criteria in the management and testing of ischemic heart disease.  The poster is a 11”x17” downloadable pdf.   The poster is also available in Chinese  and Spanish.

Case Compendium

The Refer Wisely Case Compendium is a series of common clinical scenarios that referring physicians face in their practice when deciding on appropriate diagnostic testing in patients with known or suspected coronary artery disease. Each case is presented by a nuclear cardiologist and an internal medicine specialist to ensure the content is appropriate to helping referring physicians choose the right test for their patients.
Case discussions focus on patient-centered evaluation:
  • What questions need to be answered?  
  • What tests will provide the answers?  
  • What is a proper treatment plan based on test results? 

Online Videos

Appropriate Use of Myocardial Perfusion Imaging in Women
This is an online video discussion focused on choosing the appropriate diagnostic cardiac imaging test in women, discusses details on how to differentiate  symptoms of ischemic heart disease in women versus men, applying appropriate use criteria and imaging guidelines for nuclear cardiology studies

Women with Suspected Ischemic Heart Disease: What is the Best Diagnostic Approach?
This enduring video features a panel of experts discussing gender differences, risk assessment and stratification, application of AUC, current patterns of appropriate use of nuclear cardiology testing in women, value of PET imaging in women with CVD and understanding when other modalities may be more appropriate.

Supported by Astellas Pharma Global Development, Inc.

Refer Wisely Steering Committee

David Wolinsky, MD, Committee Chair – Cleveland Clinic, Weston, FL
Dennis Calnon, MD – OhioHealth Heart and Vascular Physicians, Columbus, OH
Gretchen Diemer, MD – Thomas Jefferson University Hospital, Philadelphia, PA
Rami Doukky, MD - Cook County Health and Hospitals Systems, Chicago, IL
Rory Hachamovitch, MD – Cleveland Clinic, Cleveland, OH
Andria Medina, MD, PhD – Oklahoma University Medical Center, Oklahoma City, OK
Larry Phillips, MD – NYU Langone Medical Center, New York, NY
Raymond Russell, MD – Rhode Island Hospital, Providence, RI
Ronald Schwartz, MD – University of Rochester Medical Center, Rochester, NY
David Winchester, MD – University of Florida, Gainsville, FL

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