More imaging outcomes data sought by CMS, physicians

Studies for imaging technologies typically focus on diagnostic accuracy.

Issue: March 2009

Despite diagnostic accuracy of certain imaging methods, physicians and entities like the Center for Medicaid and Medicare Services want more outcomes data from imaging studies.

According to a presentation given by Jack A. Ziffer, MD, PhD, chief of radiology at the Baptist Hospital of Miami and director of cardiac imaging at Baptist Cardiac and Vascular Institute, new policies from CMS may request that, for certain coverage decisions, imaging studies be accompanied by outcomes data. According to Ziffer, this represents a change in the way cardiac imaging specialists approach gathering and reporting of imaging research results.

“With the exception of two patient populations, CMS proposed last year that the purpose of the research study they wanted to have this test for – the application of coronary CT angiography – potentially improves a patient’s health outcomes,” Ziffer said. “That is not something CMS had previously done in order to approve funding for an imaging study.”

While conceding that imaging studies traditionally focus on diagnostic accuracy rather than patient outcomes, Ziffer also said that the change in focus for imaging studies may be gradual. Imaging studies examining patient survival or quality of life are rare, as are imaging studies of cost effectiveness and cost utility. The pace at which the data would be gathered and analyzed, according to Ziffer, would also be slower than the advancement of the technologies.

“To develop those levels of evidence will take a long time,” Ziffer said. “In the case of rapidly developing technology, by the time that data gets developed, that technology may already be irrelevant and we will always be trying to catch up with the data, thereby impairing progress.”

Cost-effectiveness

Ziffer also explained that imaging may have potential cost-cutting benefits and societal benefits to offer, but imaging research on cost effectiveness or evaluating its effects on quality of life is scarce.

“In one case, evaluating patients with acute chest pain in the emergency department, it has been learned that by doing imaging, one can in fact reduce the costs by about $1,500 per patient by introducing something that has cost into the patient work-up,” said Ziffer. “This saves money because it prevents downstream costs associated with missed diagnosis of MI. – by Eric Raible

Computed tomography angiography provides visual insight into the presence and characteristic of coronary plaque and gives valuable information about the presence or absence of coronary stenoses. However, it is developing at a time when the rising costs of medical care in general, and cardiac imaging in particular, are being questioned by many. It seems that no one wants just pretty pictures during deficit spending. The CT community has responded responsibly, in my view, developing standards for training, scope of practice, appropriateness criteria, lab accreditation and board certification. Despite these quality measures, there are still calls for cardiac CT to prove its worth, going far beyond what has been requested in the past. Fortunately, there are dedicated individuals and medical societies ready to take up this challenge and collect the needed research data to ensure that cardiac CT is available to help with the epidemic of CVD in which we live. We look forward to more outcomes studies as well as further development of this field.

– Kim Allan Williams, MD

Cardiology Today Editorial Board member

For more information:

Ziffer gave a keynote address for a session on CT and MR research at the Radiological Society of North America 94th Scientific Assembly and Annual Meeting in Chicago.
Ziffer J. SSK02-01. Presented at Radiological Society of North America 94th Scientific Assembly and Annual Meeting; Nov. 30 – Dec 5, 2008; Chicago.