Feature | February 28, 2014

Non-Invasive CV Imaging Statement Calls for Patient-Centric Approach

Decision-making requires analysis of interplay of quality, patient outcomes, costs

CT Systems Cardiac Ultrasound MRI Nuclear Imaging

February 28, 2014 — Determining the appropriate use of cardiovascular imaging requires analyzing the “complex interplay” among care processes and their quality, patient health outcomes and medical costs, according to a health policy statement released by the American College of Cardiology (ACC) and endorsed by 14 other relevant medical societies. 

The document discusses the current understanding about the patterns and drivers of imaging use, along with patient safety and test quality. It notes that a more patient-centric approach to guiding appropriate use is needed than payer-driven reimbursement reductions and prior authorization requirements. 

Drafted by a writing committee of physicians, administrators and consumers, the statement acknowledges the dramatic increase in imaging that began in the late 1990s, which fueled concern that use was driven by an unregulated fee-for-service reimbursement system. However, the document also cites evidence of a recent drop in utilization and shows that multiple factors affect physician test ordering, including greater patient demand and defensive medicine. 

Recognizing the important different perspectives that converge in health policy, the statement warns that “simplistic causal models” connecting reimbursement with utilization can lead to bad policy that may harm patients. As examples, the document notes that prior authorization policies may seriously limit patient access to care services. Reducing reimbursement for office-based care as a way to lower costs can, and has, led to unintended shifts to more expensive hospital-based care.

As an alternative, the statement advocates a more sophisticated approach to shepherding responsible imaging use. It suggests that imaging policy could benefit from “an iterative process” using “relevant, high-quality data to guide continued efforts.”

“The current situation in non-invasive cardiovascular imaging is pretty much unsatisfactory from everyone’s point of view,” said Daniel B. Mark, professor of medicine at Duke University School of Medicine, director of outcomes research at the Duke Clinical Research Institute, and the chair of the statement’s writing group. “However, it is encouraging that we now have much more knowledge and several new informatics tools that can be used to help us apply that knowledge. We have many of the ingredients needed to create a more responsible, cost-conscious approach to imaging that still preserves — at its core — patient-physician decision making.”

Both randomized trials and clinical registries could be used to provide the needed information on patient outcomes, resource use and medical costs, the statement suggests. In addition, electronic medical records could promote the efficient use of point-of-care tools, such as appropriate use criteria and decision support systems. These resources would combine patient-specific information with statistical models and other prediction rules.

The statement moreover identifies the role physician groups play in promoting appropriate imaging use.  For example, the ACC’s FOCUS program pairs local chapters with health plans to reduce geographic variation in imaging use and lower the rate of “rarely appropriate” tests. Additionally, the American Medical Association is working to define performance measures that include the quality and appropriate use of cardiovascular imaging.

“The complexity of our current health care system and the competing macro-forces that push it in myriad different directions can make responsible imaging use seem impossibly daunting,” Mark said. “What we need is a convergence of will to make it happen from all key stakeholders. This statement hopefully is a step in that direction.”

This statement was endorsed by the American Heart Assn., American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Intersocietal Accreditation Commission, Mended Hearts, North American Society for Cardiovascular Imaging, Radiological Society of North America, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions Foundation, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance and the Society of Nuclear Medicine and Molecular Imaging. Their 2014 Health Policy Statement on Use of Noninvasive Cardiovascular Imaging was published Feb. 25 in Journal of the American College of Cardiology

For more information: www.cardiosource.org

Related Content

 MRI system cardiac scan from DeBakey Hospital
News | Magnetic Resonance Imaging (MRI) | December 05, 2019
December 5, 2019 — The following is by Lawr
MRI Exablate neuro helmet from INSIGHTEC

MRI Exablate neuro helmet from INSIGHTEC. Image courtesy of Ali Rezai, M.D., and RSNA.

News | Clinical Trials | December 03, 2019
December 3, 2019 — Focused ultrasound is a safe and effective way to target and open areas of the blood-brain barrier
Prof. Dr. Samer Ezziddin from Saarland University/Saarland University Hospital.

Prof. Dr. Samer Ezziddin from Saarland University/Saarland University Hospital. Photo courtesy of Thorsten Mohr/Saarland University

News | Prostate Cancer | November 28, 2019
November 28, 2019 — Reports of new cancer treatments
The Philips Lumify hand-held ultrasound technology is an important component of the mobile ECMO unit. Members of the ECMO team use Lumify for real-time visual guidance when inserting tubes in veins and arteries in a process called ECMO cannulation. #RSNA2019 #RSNA19 #POCUS

The Philips Lumify hand-held ultrasound technology is an important component of the mobile ECMO unit. Members of the ECMO team use Lumify for real-time visual guidance when inserting tubes in veins and arteries in a process called ECMO cannulation.

Feature | Ultrasound Imaging | November 26, 2019
November 26, 2019 — Physicians from the University of New Mexico (UNM) and local emergency responders recently treate
SonoSite iViz hand-held ultrasound fits in the palm of the users hand. It provides quick answers in tough clinical environments, both at the bedside and in the field. It combines superior imaging performance, ultra-mobility, and one-handed operation while allowing the operator to collaborate and share information with colleagues. #RSNA19 #RSNA #RSNA2019 #POCUS

The SonoSite iViz hand-held ultrasound fits in the palm of the users hand and provides quick answers in tough clinical environments, both at the bedside and in the field. 

News | Ultrasound Imaging | November 26, 2019
November 26, 2019 — Fujifilm SonoSite Inc.
Reduction in fractional anisotropy (FA) in obese patients compared to the control group

Reduction in fractional anisotropy (FA) in obese patients compared to the control group: At the intersection of the alignment vectors, a large cluster of FA decrease located in the corpus callosum on the left. In red: Reduction of FA in obese patients compared to controls, and FA skeleton (green), superimposed on the mean of FA images in sample. Image courtesy of Pamela Bertolazzi, Ph.D., and RSNA.

News | Clinical Trials | November 25, 2019
November 25, 2019 — Researchers using magn...
Image by Volker Pietzonka from Pixabay

Image by Volker Pietzonka from Pixabay

News | Pediatric Imaging | November 25, 2019
November 25, 2019 — Connectivity in an area of the brain that regulates emotion may be altered in infants exposed to