Sometimes medicine defies logic. Mainly this manifests itself in awe-inspiring diagnostics and therapies that can detect illnesses and target treatments, ultimately resulting in improved health outcomes and enhanced quality of life. Other times, though, it involves jaw-dropping bureaucratic decisions that make physicians scratch their heads, or even worse, throw up their hands in disgust.
A proposed rule by the CMS that would have denied coverage for CT angiography, and thus, put patients with heart disease at greater risk, fell decidedly in the latter category. Thankfully, in a moment of clear-sightedness, the government health policy officials ultimate decision preserved patient access.
It was a conclusion to which private payers should pay close attention. But the overall examination frustrated doctorslike meand other healthcare providers because CT angiography has widespread acceptance as a proven technology to rule out heart disease. It works with remarkable precision, accurately determining whether or not a patient has coronary artery disease 99% of the time.
I am just one of countless doctors who have found CT angiography beneficial for patients. In 2006 alonethe first year it was part of the Medicare program50,000 patients utilized CT angiography, which has been approved by local Medicare carriers in all 50 states.
From the outset, it was truly puzzling why the CMS and some private payers were reconsidering a technology that has been validated by positive data from numerous peer-reviewed scientific studies that show CT angiographys effectiveness, and proposing coverage policies that would have denied patients this important diagnostic tool.
While Medicare and private payers must consider cost in its coverage decisions, making cuts in reimbursement rates for imaging tests without the supporting data is not likely to solve any economic burden to our society, and will more likely result in increased utilization.
Indeed, if reimbursements to medical imaging are cut further, payers are likely have to increase their own healthcare tabs instead. A CT heart scan, when viewed in isolation may seem expensive, but compare the price tag of a one-time scan to the cumulative, long-term costs that will come with its regrettable alternatives: repetitive consultation, progression of disease and inappropriate treatment. Talk about penny wise and pound foolish.
To be sure, patients do not have medical scans because theyre enjoyable or because it gives them something to talk about with their friends. Patients utilize technologies such as CT angiography because their doctors see the unquestioned value of these scans as a standard of care. When faced with the choice of scan or surgery as a means of diagnosis, patients will always choose the scan. Honestly, who wouldnt?
Medicares decision is just the most recent example showing that when the data are fully evaluated, imaging continues to prove its worth through documented cost savings and improved patient outcomes. It was right for the CMS to allow the continued coverage of heart scans, and I am certain that patients across America will benefit as a result.
Mario Garcia, M.D., FACC, FACP, is director of Non-Invasive Cardiology Mount Sinai Medical Center and Professor of Medicine at Mount Sinai Medical School, New York, NY. He was selected as one of the top five most prominent cardiac-imaging specialists in the US by Diagnostic Imaging in 2005 and 2006.