Cardiovascular Business - March/April 2008 - (Page 25) good News: No Payment Cuts—In March, the Centers for Medicare & Medicaid Services (CMS) announced that it would not impose a restrictive national coverage policy for coronary CT angiography. The result leaves in tact the local coverage decisions that all 50 states and the District of Columbia have enacted to pay for CCTA. umes. Cath labs need to perform new peripheral, neurological and structural heart procedures, Maloney says. “We’re seeing the advent of hybrid labs. We need other, new procedures to replace what we’ve lost.” Most cardiology meetings now focus on carotid stenting, structural heart disease and aortic valve replacement, among other techniques that will help cath labs’ recovery. There is good reason for the studies and trials that relate to cardiac catheterization labs, says Bonnie Weiner, MD, an internist and interventional cardiologist and the current president of the Society for Cardiovascular Angiography and Interventions (SCAI). “Nobody likes to undergo procedures if they don’t need them. They want to know that the risk-benefit ratio is reasonable and appropriate.” Weiner says study data, however, must be kept in perspective and allowed to be evaluated critically from a scientific standpoint, but not portrayed in a way that unnecessarily panics patients. The COURAGE trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation), which looked at percutaneous coronary intervention (PCI) and optimal medical therapy, found that PCI is no better at preventing future events than optimal medical therapy alone in patients with stable coronary disease. But, the COURAGE trial has a tremendous number of holes, according to Yakubov. Interventional cardiologists didn’t think the study was fair, that it was biased to show medical therapy would be better than angioplasty. “In selected cases, there is no difference in mortality outcome between balloon angioplasty with stenting and medical therapy. I think every interventional cardiologist would agree with that statement. To say that everybody will do as well is misrepresenting the whole field,” Yakubov said. According to Weiner, the real message from COURAGE is that patients with stable symptoms and little ischemia will do fine on medications. “That’s a fairly small amount of the patients that we see.” The majority of the COURAGE patients had already had their angiogram and anybody who had high risk or anatomy that really dictated some kind of revascularization were excluded from this study upfront. Multislice mayhem Multidetector CT scanners also are impacting cath lab business. If smaller institutions get a high-end scanner, they can get a bet- Cath Lab Growth Rate 5 4 $3.85 $4.21 2.0 Cath Lab Device Budget $1.8 1.5 $1.5 $1.3 1.0 $1.1 Million 3 2 1 0 2002 2006 Million 0.5 0.0 2003 2004 2005 2006 From 2003 to 2006, the average device budget per cath lab increased 18 percent per year as more sophisticated devices such as drug-eluting stents were adopted. (source: iMV) While cath labs experienced a 9 percent increase in the number of cases from 2002 to 2006, it actually represents a slower rate of growth (2 percent) than in previous years. CardiovascularBusiness.com Cardiovascular Business 2 http://CardiovascularBusiness.com
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