Article preview reprinted from Medtech Insight - February 2010
Regardless of the final shape of health care reform legislation, there is little doubt that the swirling debate around that issue has highlighted an unambiguous need to reduce health system costs, increase efficiency, and improve patient outcomes. This is particularly true for high-cost diagnostics in crucial areas like cardiac care. The focus on fast-rising care costs has ratcheted up the pressure to reduce the number and fine-tune the quality of cardiac imaging procedures. And perhaps nothing signifies change in this area more than the introduction of comparative effectiveness research into the equation in the search for standards of care. Read more...
Cardiac Imaging and CER: The Search for Efficiency
Article preview reprinted from Medtech Insight - February 2010
Regardless of the final shape of health care reform legislation, there is little doubt that the swirling debate around that issue has highlighted an unambiguous need to reduce health system costs, increase efficiency, and improve patient outcomes. This is particularly true for high-cost diagnostics in crucial areas like cardiac care. The focus on fast-rising health care costs has ratcheted up the pressure to reduce the number and fine-tune the quality of cardiac imaging procedures. And perhaps nothing signifies change in this area more than the introduction of comparative effectiveness research (CER) into the equation in the search for standards of care.
James Min, MD, a New York-based specialist in the diagnosis of coronary heart disease and director of the cardiac CT labs at Cornell University's New York-Presbyterian Hospital/Weill Cornell, quantified the matter in 2008 when he stated, "For every health care dollar spent, 8% will go to a physician for imaging services." ( See Exhibit 1.) A wide-ranging panel discussion at the American Heart Association (AHA) 2009 Scientific Sessions last fall in Orlando, FL, further examined the subject, and based on the discussion there, it is clear the cardiology community is catching on to the need for improved, lower-cost, better targeted testing of patients suffering from coronary artery disease (CAD).
Cardiac Imaging a Logical Target for CERSpending on cardiac imaging procedures began a sharp rise in the 1990s and that dramatic growth surge caught the eye of third-party payors, says Raymond J. Gibbons, MD, professor of medicine in the department of cardiovascular diseases at the Mayo Clinic College of Medicine, Rochester, MN, a panelist at the AHA session. He pointed out that the volume of cardiac stress imaging procedures paid for by Medicare grew far faster than other imaging procedures, faster than even cardiac cath lab imaging and revascularization did in the 1990s.
What's more, he said, this growth continued in the 2000s, with single photon emission computed tomography (SPECT) expanding threefold between 1998 and 2006. Computed tomography and magnetic resonance imaging (CT/MRI) grew as well, as did positron emission tomography (PET) during that same time period. In fact, from 1995 to 2005, use of CT/MRI and PET expanded fourfold, a full 16% per year increase compounded over 10 years.
Between 2000 and 2006, Medicare spending on imaging more than doubled while imaging shifted from hospital settings to independent diagnostic testing facilities and physician offices. The enormous escalation in spending associated with this growth ignited push-back from the system, culminating in deep cuts proposed for 2010 Medicare expenditures, which include a 36% slash in SPECT imaging reimbursements and a 10% reduction in payments for echocardiography services. Modest reimbursement increases were initially proposed, but later pulled back, said Gibbons.
by Curt Werner
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Companies mentioned in this article:
Brigham and Women's Hospital
Columbia University
New York-Presbyterian Hospital
Cornell University
Duke University
Emory University
Emory University School of Medicine
Guy's & St. Thomas' Hospital NHS Trust
Harvard University
Harvard Medical School
Massachusetts General Hospital
Mayo Clinic College of Medicine
National Institutes of Health
National Heart, Lung and Blood Institute
US Department of Health and Human Services
University of California
University of California, Los Angeles
University of Pennsylvania
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