In a victory for advocates of coronary CT angiography (CTA), the U.S. Centers for Medicare and Medicaid Services (CMS) today decided to make no change to the way it reimburses for coronary CTA exams. With the decision, CT advocates have dodged a bullet that many feared could have killed the promising new field of cardiac imaging with CT.
CMS announced in December 2007 that it was proposing a National Coverage Decision (NCD) that would have severely limited Medicare payments for coronary CTA exams. The NCD proposal would have eliminated all Medicare reimbursement for the exam save for two indications, further stipulating that coronary CTA must be performed within the confines of a controlled clinical trial to be reimbursed.
CT advocates were outraged, and healthcare providers from both radiology and cardiology wrote to CMS during the NCD comment period, urging the agency not to effectively kill an exam that many see as a promising alternative to catheter-based angiography. CMS reported that it received 670 comments on the proposed decision.
The outpouring apparently had an impact. In a memo posted on its Web site on March 12, CMS stated that it has decided to leave existing policy in place.
"We have decided that no national coverage determination on the use of cardiac computed tomography angiography for coronary artery disease is appropriate at this time and that coverage should be determined by local contractors through the local coverage determination process or case-by-case adjudication," the memo stated.
Despite that statement, CMS said it still has concerns about the clinical effectiveness of coronary CTA. The agency conducted an extensive review of the literature on coronary CTA, but remains unconvinced of the technology's utility.
"No adequately powered study has established that improved health outcomes can be causally attributed to coronary CTA for any well-defined clinical indication, and the body of evidence is of overall limited quality and limited applicability to Medicare patients with typical comorbidities in community practice," the agency said.
However, CMS decided to leave the current coverage policies in place in light of the public comments and specialty society opinions recommending that coverage decisions be left to local carriers. The agency said that any future National Coverage Decision will depend on "peer-reviewed publication and critical evaluation of convincing new evidence."
The agency concluded by stating that current guidelines are inadequate in providing guidance to patients and healthcare providers on how coronary CTA should be incorporated into the workup of patients with chest pain. CMS is further concerned that providers are using coronary CTA as an additional test to exercise stress testing and nuclear imaging, rather than considering a mix of tests. The agency encouraged specialty societies to develop guidelines for more appropriate usage of coronary CTA.
One group that applauded the CMS decision was the Medical Imaging and Technology Alliance (MITA), a division of the National Electrical Manufacturers Association (NEMA) of Rosslyn, VA. CMS' decision will benefit Americans who would have been subjected to more invasive and expensive inpatient procedures if the proposal had been accepted, according to MITA vice president Andrew Whitman.
"CMS should be commended for considering the full scope of established evidence and clinical analysis in formulating its CCTA decision," he said. "CCTA has revolutionized the way doctors diagnose heart disease, and I am pleased that CMS' final decision acknowledges CCTA's scientifically proven effectiveness."
By Brian Casey
AuntMinnie.com contributing writer
March 12, 2008
Related Reading
How 64-slice CT saved my life: An administrator's story, February 28, 2008
Coronary CTA's time is now, according to Dowe, January 17, 2008
Coronary CTA study aims for lowest dose, January 11, 2008
Pending Medicare decision roils cardiac CTA, January 8, 2008
Low-dose coronary CTA diagnoses most patients, November 28, 2007
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