Policy statement: Noninvasive CV imaging requires patient-focused approach

A policy statement released today by the American College of Cardiology and endorsed by 14 other relevant medical societies states that determining the appropriate use of noninvasive CV imaging requires a “patient-centric” approach among care processes and their quality, patient health outcomes and medical costs.

The statement, published in the Journal of the American College of Cardiology, 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 statement also cites evidence of a recent decrease in utilization and shows that multiple factors affect physician test ordering, according to a press release.

“The current situation in noninvasive CV imaging is pretty much unsatisfactory from everyone’s point of view,” Daniel B. Mark, MD, MPH, professor of medicine at Duke University School of Medicine and chair of the writing group, stated in the release. “However … 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.”

The statement discusses the current understanding of patterns and drivers of imaging use, patient safety and test quality. The authors note that a more patient-centric approach to guiding appropriate use is needed than payer-driven reimbursement reductions and prior authorization requirements, according to the release.

The authors caution against causally linking reimbursement with imaging use, as this may cause harm to patients or patients may have limited access to care as a result of prior authorization policies. Also, they noted, a reduction in reimbursement for office-based care can result in increased costs for hospital-based care.

The statement calls for an imaging policy governed by an “iterative process” that incorporates “relevant, high-quality data to guide continued efforts,” and combines models and prediction rules with information specific to the patient to guide imaging use. Data on outcomes, costs and use of resources could be collected from clinical registries and randomized trials, while the use of electronic medical records could aid in the application of decision support systems and appropriate use criteria, according to the authors.

In addition, the statement identifies the role of physician groups in the promotion of appropriate imaging use.

“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 stated. “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.”

For more information:

Mark DB. J Am Coll Cardiol. 2014;63:698-721.