A more sophisticated, patient-centric model is needed to guide appropriate use of non-invasive cardiovascular imaging, according to a policy statement by the American College of Cardiology and endorsed by 14 other relevant medical societies.
The document states that echocardiography, CT, MRI and positron emission tomography scanning are all now routinely done, but the pace of innovation has outpaced the research supporting its use. And, how quickly the procedures have grown in frequency, particularly between 1999 and 2006, appears to have been driven by something other than changes in the health care needs of the patient population. A pooled analysis of 6 large health maintenance organizations between 1996 and 2010 showed that CT studies increased 3-fold, MRIs increased almost 4-fold, and ultrasound increased by 70%.
Reducing reimbursement for office-based care as a way to lower costs can, and has, led to unintended shifts to more expensive hospital-based care, the statement argued. Instead, the appropriate use of cardiovascular imaging requires a closer look at care processes and their quality, patient health outcomes and medical costs.
“The current situation in non-invasive cardiovascular imaging is pretty much unsatisfactory from everyone’s point of view,” stated Daniel B. Mark, MD, FACP, the chair of the statement’s writing group. “However, it is encouraging that we now have much more knowledge and several new informatics tools that can be used to help us apply that knowledge. 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.”
A more patient-centric approach to guiding appropriate use is needed than payer-driven reimbursement reductions and prior authorization requirements. As an alternative, the statement suggests that imaging policy could benefit from “an iterative process” using “relevant, high-quality data to guide continued efforts.”
Both randomized trials and clinical registries could be used to provide the needed information on patient outcomes, resource use and medical costs, the statement suggests. In addition, electronic medical records could promote the efficient use of point-of-care tools, such as appropriate use criteria and decision support systems. These resources would combine patient-specific information with statistical models and other prediction rules.
“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,” said Dr. Mark. “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.”
The Health Policy Statement on Use of Noninvasive Cardiovascular Imaging appears online at the American College of Cardiology’s website and will appear in the Feb. 25 issue of the Journal of the American College of Cardiology.