The shutdown of GE Healthcare's Shanghai, China, plant that began in April has caused a global shortage of the iodinated contrast media iohexol (Omnipaque). GE reports that it has returned to a 75% production rate, with a return to close to 100% production the week of June 6.
Sandy Coffta.Alternative contrast agents such as iodixanol (Vispaque, GE) and ioversol (Optiray, Guerbet) are becoming scarce as practices have shifted to using those products instead of iohexol. As of May 31, Omnipaque, Vispaque, and Ultravist (iopromide, Bayer) have been added to the U.S. Food and Drug Administration's list of drug shortages.
The American College of Radiology (ACR) encourages practices to contact their local GE diagnostic pharmaceutical representative for the most current information. In addition, the ACR offers risk mitigation strategies and other resources on its website. Above all, the ACR stresses the need for sound clinical judgment in all decisions affecting patient care.
Practices have found that ordering physicians are inappropriately ordering studies without contrast, which necessitates a phone call from radiologic technologists to have orders changed. The ACR notes that its Appropriateness Criteria Portal can be used to search for alternative imaging studies for a given indication (that may not require contrast material) by clicking the "Explore by scenario" icon.
One strategy being employed by radiology practices and hospitals is to conserve their supply of contrast material by deferring nonemergent contrast exams or to perform noncontrast studies when possible. Another strategy is to use MRI in place of contrast CT exams when it is clinically appropriate.
In response to a joint letter from the ACR and the Radiology Business Management Association (RBMA), UnitedHealthcare addressed both the improper ordering and deferral concerns. United states, "Providers seeking to modify the [current procedural terminology] CPT code for a completed notification/authorized CT with contrast procedure, to a noncontrast CT, will not be required to notify UnitedHealthcare to modify the existing notification/prior authorization record for CPT code combinations." United notes that its approved combinations of CPT codes are available online under the Specific Radiology Programs heading.
United also reports, "During the contrast shortage, at the time of the initial request, providers can also request an extension for the duration of an authorization for a CT with contrast from the standard 45 days to up to 90 days, recognizing that many nonemergent and elective procedures may be rescheduled during this time."
Radiology groups should work with their ordering physician community to make them aware of these two aspects of prior authorization from UnitedHealthcare, and check with other carriers about their policies, as well.
The shortage is affecting hospitals and radiology groups in different ways, according to an RSNA panel discussion recently covered by AuntMinnie.com. Some report no real issues due to a diverse supply chain, the size of the organization, and their ability to share supplies across their network of facilities. Smaller institutions and practices that have concentrated their contrast purchasing in one product line will be impacted more severely.
The situation is dynamic, with new updates appearing almost daily. So far, UnitedHealthcare is the only payer to respond to the ACR/RBMA letter. We will update this article as we learn new information that will be useful to our readers.
What's more, GE Healthcare said in a June 2 press statement that it expects the Shanghai plant to return to close to 100% production volume the week of June 6.
As the ACR recommends, the best information about supplies will be available from your pharmaceutical supply representative.
Sandy Coffta is the vice president of client services at Healthcare Administrative Partners.
The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.
