As the Centers for Medicare & Medicaid Services comb through reimbursement codes to identify potentially misvalued codes, radiology is disproportionately targeted, primarily because of the specialty’s historic accuracy in coding, according to an article in the January issue of Journal of American College of Radiology. The article pinpointed three sources of bias against radiology services.
Applying cardiac CT to the evaluation of patients who present to the emergency department (ED) with chest pain at low to intermediate risk of acute coronary syndrome saved money in both the initial diagnosis and over a one-year period, according to a decision analytic model published in the January issue of Academic Radiology.
GE Healthcare has paid the U.S. $30 million, plus interest, to settle allegations that a company it acquired in 2004, Amersham Health, had violated the False Claims Act by causing Medicare to overpay for Myoview, a radiopharmaceutical used in certain cardiac diagnostic imaging procedures, according to the U.S. Department of Justice.
The Medicare Payment Advisory Commission (MedPAC) has confirmed the recent downward trend in Medicare spending and utilization on medical imaging procedures and said imaging services declined by 2.5 percent in 2010.
Medical device makers are counting on financial stratagems—buybacks, dividends, acquisitions and the like—to keep shareholders happy in the face of flat sales figures. The drop in demand owes in large part to belt-tightening at hospitals, tougher approval procedures at the FDA, declining medical coverage under health-insurance plans and a weak global economy.
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule Dec. 13 that will increase public awareness of financial relationships between drug and device manufacturers and certain healthcare providers. This is a provision under the Patient Protection and Affordable Care Act.
The U.S. House of Representative passed the Middle Class Tax Relief & Job Creation Act (H.R. 3630) Dec. 13. Among other things, H.R. 3630 prevents an across the board 27 percent cut to Medicare physician reimbursement statutorily required by the Sustainable Growth Rate (SGR) formula. The bill provides physicians with a 1 percent increase in Medicare payments for 2012 and 2013.
While overall imaging costs are increasing faster than overall Medicare cancer care costs, 18F-FDG PET or PET/CT account for approximately 1.5 percent of Medicare cancer care expenditures, according to an economic analysis published online in a December supplement to the Journal of Nuclear Medicine.
Women diagnosed with breast cancer are increasingly burdened by multiple imaging appointments prior to surgery, according to researchers from Fox Chase Cancer Center in Philadelphia, who presented the findings Dec. 9 at the San Antonio Breast Cancer Symposium.
CHICAGO—Due to changes in CPT coding and fee schedules that have reduced reimbursement for stress tests and coronary CT angiography (CCTA) in the 2009 through 2011 Medicare fee schedules, triage strategies that begin with stress EKG or stress echocardiography and progress to CCTA (if the stress test is positive) represent the least expensive options, and are more cost-effective relative to strategies that utilize myocardial perfusion scintigraphy, according to a study presented Nov. 30 at the 97th annual meeting of the Radiological Society of North America (RSNA).
Written by Kathy F. Mahdoubi
While 18F-FDG PET is the gold standard for evaluating and managing patients with lung cancer, recent data have shown it also could be beneficial in diagnosing, staging and monitoring of small cell lung cancer.
While the Centers for Medicare & Medicaid Services (CMS), in response to American College of Radiology (ACR) data, and a furious reaction from the imaging community, revised the multiple procedure payment reduction for interpretation of imaging from 50 percent to 25 percent, the 25 percent cut is still "unfounded and potentially dangerous," the ACR maintained in a Nov. 3 statement. The unanticipated final rule expansion of this reduction to include multiple providers within the same group practice violates the spirit of the rulemaking process and indicates that CMS fundamentally misunderstands the practice of medicine, according to the ACR.
Reps. Pete Olson (R-Texas) and Betty McCollum (D-Minn.) introduced H.R. 3269 in the U.S. House of Representatives on Oct. 27. Co-sponsored by 31 House Members, the Diagnostic Imaging Services Protection Act would prohibit any multiple procedure payment reduction to the “professional component” of CT, MRI and ultrasound exams received by the same patient, on the same day, in the same setting in 2012.
A new analysis verified and strengthened earlier studies that demonstrated the link between financial interest in imaging and greater utilization of imaging. The research, published in the November issue of American Journal of Roentgenology, led the authors to suggest that cost-containment efforts target financial interest in imaging.
The FDA and the Centers for Medicare & Medicaid Services (CMS) have launched a pilot program to conduct parallel reviews of medical devices for concurrent FDA approval and Medicare coverage.
The Blue Cross and Blue Shield Association (BCBSA) has issued a plan that would move the healthcare system away from a fee-for-service model to a patient-centered model. However, the Medical Imaging and Technology Alliance and Access to Medical Imaging Coalition have called on Congress to reject the BCBSA proposal that would call on Medicare to use prior authorization for advanced imaging services.
High unemployment, increasing enrollment in Medicaid and an otherwise dismal economy have affected the medical technology market, according to a recently released Ernst & Young report, “Pulse of the industry: Medical technology report 2010.” With uncertainties ahead, the authors write, many hospitals are holding onto their dollars.
Infinitt North America, a developer of image and information management technologies for healthcare, has received FDA clearance for its fusion software, Xelis Fusion. The software is now available to the North American market.
Imaging cuts in the administration’s deficit reduction proposal would restrict patient access to care and may actually raise costs, according to the American College of Radiology (ACR). The college has urged the Joint Select Committee on Deficit Reduction to reject the Obama administration’s imaging recommendations and work with the ACR and other imaging stakeholders to create policies that ensure safe, appropriate care, promote quality and protect patient access.
The Department of Health and Human Services (HHS), along with several association and industry partners, has launched Million Hearts, an initiative that aims to prevent one million heart attacks and strokes in the U.S. over the next five years. Currently, cardiovascular disease (CVD) costs $444 billion every year in medical costs and lost productivity for people living in the U.S.
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