Matters of the heart

The big news this week was of course Congress’ passing of a temporary patch to once again stave off the flawed sustainable growth rate (SGR), which would have slashed Medicare physician reimbursement. As you’ve probably heard by now, the bill also delays implementation of ICD-10 codes sets another year—to October 2015—and of particular interest to the imaging community, the bill also requires ordering providers to consult physician-developed appropriateness criteria when recommending advanced imaging procedures for Medicare patients. You can read more here and here.

While the SGR saga was deservedly the biggest headline this week, a number of the other most read stories came from the area of cardiovascular imaging.

The American College of Cardiology (ACC) held their annual meeting and scientific session in Washington, D.C., last weekend, and the latest in cardiac imaging was on display. Ricardo C. Cury, MD, of Baptist Hospital of Miami, gave a presentation touting the advances in research for CT in the emergency department (ED). He highlighted a trio of recent studies—the CT-STAT trial, ACRIN-PA and the ROMICAT-II trial—among others that showed integrating coronary CT angiography in a triage strategy for suspected acute coronary syndrome was feasible, cost-effective and did not result in any missed diagnoses compared with the standard of care.

Another of this week’s top ACC imaging stories came from a poster presentation that looked at downstream costs following stress echocardiography in Medicare beneficiaries. A group of Cleveland Clinic researchers found that race significantly impacted two-year cardiac costs, with cardiac charges 31 percent lower for non-white patients. This was in spite of the fact that the non-white patient population in the study had a significantly higher rate of certain risk factors like smoking and hypertension.

The final top story on the cardiovascular imaging front came from the Society for Cardiovascular Angiography and Interventions (SCAI) which released a list of procedures that should be heavily scrutinized or avoided altogether as part of the “Choosing Wisely” initiative. Included in SCAI’s recommendations to avoid were:

• Coronary angiography after CABG and PCI if patients are asymptomatic or have normal or mildly abnormal stress tests and stable symptoms;
• Coronary angiography to determine risk in patients with stable ischemic heart disease who are unwilling or unable to undergo revascularization; and
• Coronary angiography to evaluate risk in patients with no symptoms or evidence of ischemia or other problems based on noninvasive testing.

Like the provision in the SGR bill to consult appropriateness criteria before advanced imaging, SCAI’s recommendations should help to limit unneeded testing and improve care.

-Evan Godt
Editor – Health Imaging