Feature | May 15, 2009 | William Shea, M.D.

CCTA to Jump Hurdles

While growth for disruptive technologies is coming, it’s all about timing.

The majority of respondents believe that CT volumes will increase in 2009. Most facilities do not plan to purchase CT scanners in the next year. The difference between smaller imaging systems and larger imaging systems is not statistically significant.

The MarkeTech Group (TMTG) conducted a poll of its imagePRO opt-in panel of over 600 U.S.-hospital based imaging administrative directors and managers. Manuel Andrade, TMTGs research analyst, made the analysis.

Many experts lauded multidetector computed tomography (MDCT) and cardiac computed tomography angiography (CCTA) as disruptive technologies that would abruptly alter the standard of care for those with coronary artery disease. Now, years later, CCTA is slowly gaining acceptance in the medical community, both by providers, payers and administrators. Why so slowly? Perhaps the answer is simply timing.
What are the hurdles? The ones that play a role include cost, radiation safety, the economy and the need for evidence-based clinical outcomes.
Cost of Healthcare
In the last decade, the cost of healthcare in the U.S. and especially medical imaging has skyrocketed. Expensive diagnostic exams became a target for cost containment, which would explain the non-coverage determinant for CCTA by CMS in December 2007, and the ensuing coverage confusion that followed. CMS and the insurance industry simply will not support the use of CCTA as another layer of cost.
Any medical center or practice interested in developing a cardiac imaging program adopted a conservative approach. At the date of this writing, all local Medicare intermediaries and most commercial payers do reimburse for CCTA. However, reimbursement is based on Local Coverage Determinants that vary greatly in the details, and it is the attention to these details that determines appropriate reimbursement. CMS has solicited requests for input into CPT code development, but until there is a clear demonstration that CCTA is cost effective and adds value, we still face the cost restraints that are in place.
Radiation Safety
Secondary effects of radiation exposure are top of mind in the medical community and the general public. Several peer review studies and editorial reviews have highlighted the risks of inadvertent over-utilization of CT scanning, especially in the younger population.
To address this issue, the ACR has adopted the “Image Gently” program, and manufacturers have developed dose reduction strategies. Excellent articles like those from Mayo, et al, (AJR) have delineated the risks when imaging is appropriately performed. We will need to continually monitor this issue and ensure that the appropriate utilization of MDCT prevails.
Economic Recession
Obviously, no one predicted the sudden global collapse of the economy last year. This has further limited growth of CCTA programs. Capital budgets have been slashed, purchases put on hold and FTEs dismissed. Systems must be efficient and, at the very least, cost neutral or they face the piper.
While this is no time for expansion into an arena with questionable reimbursement, fortunately, recent studies have demonstrated cost savings when CCTA is used appropriately. For example, in the ED setting, a negative CCTA allows for safe and rapid discharge, saving a great deal of expense in unnecessary admissions and time of stay. In the office setting, those patients with a confusing presentation can be carefully evaluated with CCTA, reducing the number of more invasive and expensive catheterizations.
Need for Evidence-Based Clinical Outcomes
The recent National Forum on “Appropriate Coverage of Coronary CT Angiography,” organized and sponsored by the SCCT, brought together influential providers and payers to discuss the issues currently surrounding CCTA usage. Payers perceive a lack of evidence that CCTA improves clinical outcomes. This exam must demonstrate this benefit before reaching acceptance.
But how do we measure an improved outcome? There are no definable metrics in place, but rapid and safe discharge, decreased utilization of downstream imaging, and modified patient behavior are being studied. Prospective randomized multi-institutional studies are expensive (especially in this economy) and time-consuming, but must be performed and must confirm these benefits.
So while we must continue to cross these hurdles, the one positive aspect is that they have brought together many groups in a collegial and cooperative way in an effort to educate our industry, medical colleagues and our patients to the potential benefits of this wonderful new capability.
It is up to us to jump these hurdles as quickly as possible.

For more information: The MarkeTech Group

Related Content

Houston Methodist Hospital Enters Multi-Year Technology and Research Agreement With Siemens Healthineers
News | Imaging | August 17, 2017
Houston Methodist Hospital and Siemens Healthineers have entered into a multi-year agreement to bring cutting-edge...
Four Blue Cross Blue Shield Companies Issue Positive Medical Policies on HeartFlow FFRct Analysis
News | Computed Tomography (CT) | August 09, 2017
HeartFlow Inc. announced that four Blue Cross Blue Shield companies have each issued a positive medical policy for the...
The American Lung Association created LUNG FORCE, a national movement to defeat lung cancer
News | Lung Cancer | August 02, 2017
To raise public awareness of lung cancer—the leading cancer killer of men and women—the American Lung Association's...
GE’s DoseWatch is a digital informatics solution that automatically collects, monitors and reports on radiation dose indices for diagnostic imaging exams
News | Radiation Dose Management | July 31, 2017
GE Healthcare announced that it has licensed computed tomography (CT) organ dosimetry technology developed at Duke...
Contrast Media from Bayer, trends in contrast media and developments in contrast media
Feature | Contrast Media | July 28, 2017 | By Dave Fornell
Here are several updates in medical imaging ...
New York Hospital Finds Significant Cost Savings With Toshiba’s Aquilion One CT
News | Computed Tomography (CT) | July 25, 2017
In five years, Kaleida Health’s Stroke Care Center (SCC) at the Gates Vascular Institute in Buffalo, N.Y., has realized...
Samsung Introduces FDA-Cleared BodyTom Elite CT Scanner
Technology | Computed Tomography (CT) | July 24, 2017
Samsung announced U.S. Food and Drug Administration (FDA) approval of the BodyTom Elite, an upgraded version of its...
Sponsored Content | Videos | CT Angiography (CTA) | July 21, 2017
DAIC and ITN Editor Dave Fornell discusses some of the most innovative new computed tomography (CT) technology and tr
ACR Updates Radiation Oncology and Medical Physics Guidance With ASTRO and AAPM
News | Radiation Dose Management | July 19, 2017
July 19, 2017 — The American College of Radiology (ACR) recently collaborated with professional medical societies to
Sponsored Content | Videos | CT Angiography (CTA) | July 19, 2017
Matthew Budoff, M.D., FACC, professor of medicine, David Geffen School of Medicine at UCLA, endowed chair of preventi
Overlay Init