Cardiovascular Business - March/April 2008 - (Page 36) News & views W á Multi-societal effort to keep CCTA reimbursement PAYS OFF ers and policy makers. “The cross-industry effort to put facts and information on the table were very positive,” said Gene Saragnese, vice president and general manager of CT and molecular imaging at GE Healthcare. In response to advocacy efforts, approximately 80 members of the U.S. House of Representatives sent a letter to CMS urging them to reconsider the proposed national coverage determination, while at least a dozen U.S. Senators sent individual letters to CMS expressing their concerns. “We worked closely with CMS to present all the evidence,” Whitman said. We obviously thank the members of Congress, who were very concerned about this proposed decision. However, we worked closely with CMS, and brought CCTA experts from all over the country to show evidence that has been published, as well as evidence that is in the pipeline to be published to show the value of the test.” With the decision, CMS maintained the status quo that coverage should be determined by local contractors through the local coverage determination process or on a case-by-case adjudication. All 50 states and the District of Columbia have enacted local coverage determinations for CCTA. When CMS first proposedthecoverage decision in December 2007, it requested public comment. The agency reported that it received 670 comments, 10 of which agreed with the decision, while 649 opposed it, and the remaining provided no clear direction for coverage. CMS gave the cardiovascular societies The government did not initiate a restrictive payment and the imaging in- policy regarding coronary CTA. (source: GE Healthcare) dustry the opportusion as an ominous sign for nity to respond, and it “weighed the future of CCTA coverage. the evidence that was presented He agrees that questions about very seriously to produce a CCTA, in particular, its longpositive result,” according to term outcomes, do remain. Saragnese. CMS also showed its “Until the modality stops commitment to this process by evolving, the indications alnever denying patients’ access to ways need to be considered,” CCTA through this investigahe said. tion, he pointed out. In the mean time, the variThe CMS final decision memo ous specialties involved in this notes that “the use of CTA has effort recognize the value of increased over the years due to working together. The multiadvances in the technology and pronged and multi-societal rapid diffusion of the machines approach to educating various outside the hospital settings. factions on Capitol Hill has However, questions remain on proven to these stakeholders the indications for use.” that they need to continue to While the current decision unify to tackle difficult issues, leaves an opening for CMS to Williams said. revisit the issue later, Williams By Justine Cadet does not view this final deci- hen the Centers for Medicare & Medicaid Services (CMS) announced in mid March that it would not restrict reimbursement for coronary CT angiography (CCTA), the celebration crossed specialty and societal lines. “This decision is something that can be observed in the long-term, because it garnered societies from both sides of the aisle—cardiology and radiology—to work together to alter the path of CMS,” Kim Allan Williams, MD, American College of Cardiology co-chair, told Cardiovascular Business. Some societies within the coalition, such as the Society of Cardiovascular Computed Tomography (SCCT) and the Medical Imaging & Technology Alliance (MITA) approached Congressional members to optimize exposure to the situation, Williams said. Others relied on phone calls and emails to Congress to point out the clinical benefits of CCTA to triage patients with coronary artery disease. Andrew Whitman, vice president of MITA, said that his organization worked closely with SCCT, the North American Society for Cardiac Imaging, ACC, American College of Radiology and others to educate lawmak- 36 Cardiovascular Business March/April 2008
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