Regarding Medicare to continue covering CT heart scans:
The CMS decision to withdraw its proposed national coverage decision, and to continue to depend on local carriers is a victory for patients and physicians alike. The proposal would have overturned the precedent of local determination of coverage, and ignored a vast body of clinical evidence regarding the accuracy of cardiac CT for identifying and characterizing coronary heart disease.
Medicares comment that the agency currently lacks sufficient evidence that CT heart scans diagnose the presence of heart disease as well as invasive coronary angiography is not an accurate reflection of the literature and clinical experience with this imaging technique, but rather, reflects the injection of politics into the process of technology assessment.
Their proposed change in policy was based upon an evaluation of only a selected small share of the literature on the utility of cardiac CT, including unreferenced opinion and reports of olderfour-, eight- and 16-detectortechnology, intentionally excluding newer reports of results obtained using 64-detector scanners. The medical evidence did not change Medicares position.
That evidence was there; it was simply ignored in order to support their conclusion that cardiac CT wasnt worthwhile. The actions of the medical imaging community (including Cardiologists, Radiologists, scanner manufacturers, and patients themselves) brought this attempt to control cardiac imaging to light, and forced Medicare to back down. It would be enlightening to bring the basis for this proposedand rescindedpolicy change to the public eye.
Lawrence Boxt, M.D., F.A.C.C.Director of cardiac MRI and CTDivision of CardiologyNorth Shore University HospitalManhasset, N.Y.
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