Cardiovascular Business - January/February 2008 - (Page 36)

News & views á societies blast government’s decision to restrict Cta payment Poon, MD, an associate professor of medicine at Mount Sinai Medical Center in New York City and president of the Society of Cardiovascular Computed To m o g r a p h y (SCCT). “This is typical of governmental policy changes, where there is no clear evidence who is going to pay for the trial,” said Poon. It is often the case that with restrictive research protocols academic institutions are the only facilities capable of funding and maintaining such research. The losers are smaller, rural hospitals and clinics that could not afford to conduct randomized control studies and, therefore, could not offer their Medicare patients the benefit of CCTA, Poon told Cardiovascular Business. “Normally, going from local to national is a good sign because it indicates the entire country is willing to undertake the same standards, has confidence in a technology, and CMS is willing to pay for it. But this time, the national coverage decision has an additional aspect called coverage with evidence development,” Poon said. Medicare’s actions are unprecedented because more than 90 percent of healthcare is done at the local level. Very few procedures are given national coverage, he said. Poon is not alone. “I believe that CMS wants to do what is best for their beneficiaries. However, I also believe that its analysis of CCTA was premature. I don’t think the government yet appreciates the advances in the field that could lead to improvement in diagnosis and cost savings that will ensue if the test is utilized and reimbursed properly,” said Kim Allan Williams, MD, director of nuclear cardiology at the University of Chicago. Unfortunately, private payers generally adopt CMS proposals, especially when they perceive that it might result in cost-savings for them, Williams said. According to the letter, six reasons exist why CMS should not adopt the proposed policy change: → CMS did not conduct an adequate, thorough analysis of all available relevant evidence. It excluded from review about 75 percent of the available literature supporting CCTA utilizing 64-slice CT scanners. → CMS only referenced one out of four multi-society studies that evaluate the appropriateness of CCTA. → CMS ignored several wellestablished applications of CCTA including for coronary artery anomalies, to clear up prior equivocal test results, to assess bypass graft location, and coronary artery evaluation prior to noncardiac surgery. → Several definitions of patient populations by CMS conflict with those established by the 2007 ACC/AHA guidelines. → The questions that CMS outlined for clinical studies to qualify for coverage with evidence development are inappropriately defined and are unlikely to yield beneficial information. → Finally, local coverage determinations have fostered the development of groundbreaking clinical trial research and registry data collection to answer questions about the utility of CCTA. In juxtaposition, the societies say that the proposed national coverage decision will only slow the development of evidence by academia, societies, and registries rather than accelerate it. The statement was jointly submitted by the American College of Cardiology, American College of Radiology, American Society of Nuclear Cardiology, North American Society of Cardiovascular Imaging, Society for Cardiovascular Angiography and Interventions, and SCCT. By Justine Cadet T he comment period to halt “profoundly negative” changes to Medicare reimbursement for coronary CT angiography may have closed, but cardiologists have kept on their gloves preparing for a long battle. CMS said it wants more evidence of CCTA’s efficacy and has proposed establishing clinical trials to get it—practically negating the swift adoption by all 50 states to allow reimbursement on the local level. The policy change could take effect as early as March 13. At the end of January, cardiovascular societies sent a letter to CMS denouncing the proposed changes, insisting they would have a “profoundly negative impact on Medicare beneficiaries.” CMS has now left the recommended trial in the hands of the industry, said Michael Cardiovascular Business January/february 2008

Table of Contents Feed for the Digital Edition of Cardiovascular Business - January/February 2008

Cardiovascular Business - January/February 2008 Contents The Ticker: Quality Pays in Several Ways Cover Story: The Proof: Why Evidence-based Medicine Improves Cardiac Care Clinical Study Digest: Co-payments and Cath Labs Cardiac PET/CT Fills in Gaps Left by SPECT Tapping into IT to Improve the Office-Based Practice SPECT–Proving Its Value Cardiac Images in the EMR: Just a Click Away The Top 20 Ways to Market Your Cardiac CTA Practice The Big Picture: Medical Displays for Cardiac Images Statins Work But Pharmacoeconomic Caveats Abound Driving Data Protection: Opting for Storage On- or Offsite News & Views Calendar Reader’s Resource

Cardiovascular Business - January/February 2008

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