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CTA specialists stress need for evidence to avert national coverage decision
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CHICAGO – Cardiologists and specialists who utilize CT imaging need to stay focused on evidence and stick to appropriate criteria, according to a presentation at the Fourth Annual CT Angiography for the Cardiologist Meeting.
After the withdrawal of the Medicare board’s recently proposed national coverage decision, cardiologists and CT angiography specialists are looking to shore up outcomes data and evidence, according to John R. Lesser, MD, associate cardiologist at the Minnesota Heart Institute in Minneapolis. Lesser gave a presentation assembled by Michael Poon, MD, associate professor of medicine at Mount Sinai School of Medicine in New York.
The proposed national coverage decision threatened to supercede the functions and decisions of local coverage decisions, which some feared would have meant the end of CT angiography.
“There was a multisocietal approach that included the American Society of Nuclear Cardiology, the Society of Nuclear Cardiology, the Society of Cardiovascular Computed Tomography and other societies including the American College of Radiology and the American College of Cardiology as a general rubric, that presented a combined document about the actual knowledge of CT angiography,” Lesser said during the presentation. “Their response was that there were a lot of data at the time, but only a few 64-slice studies, and that most of the data that were useful for CT had not been reviewed and that the national coverage decision would end up basically killing the technique.”
Lesser and others at the meeting also acknowledged the need for CT specialists to focus on following appropriateness criteria and gathering outcomes data to avoid further initiatives like the national coverage decision from being implemented due to a lack of clinical evidence.
“The bottom line was that they said that the evidence was not enough, but they raised the bar and said that imaging studies had to change clinical outcomes,” Lesser said. “The issue there is that if that is true – and there are many further decisions that follow an imaging study – that raises the bar to the point that one has to expect that it would be difficult to cover anything in the future.” — by Eric Raible
For more information:
- Lesser J, Poon M. The current reimbursement situation for cardiac CT. Presented at: the Fourth Annual CT Angiography for the Cardiologist Meeting; May 9-10, 2008; Chicago.
The fact that Medicare has decided not to approve a national coverage decision at this point is a reprieve, but it is still coming. We are going to need more evidence. All of us are recognizing, even when we opposed the national coverage decision because it would have killed the field, that we need to really keep after it and to answer the perfectly legitimate questions that were asked by the Medicare panel. It is hard to imagine anyone saying we do not need more evidence or we do not need more outcomes studies. How long we have and whether or not they are going to come back at us for more evidence I cannot say, and do not think they can, either. This is the reprieve; the case has not been dismissed yet.
– Samuel Wann, MD
Cardiology Today Section Editor