A Diagnostics & Imaging Week

Cardiologists trying to assess a patient's vulnerability to sudden cardiac death have more instruments available than ever before, including measurements of the microvolt T-wave alternans (MTWA) phase of the heartbeat, during which the ventricles recharge prior to contraction.

However, the currently reimbursed method of measuring the MTWA, known as spectral analysis, is subject to noise and is little help in measuring the MTWA when the patient is active. Hence cardiologists and electrophysiologists are keen on getting the Centers for Medicare & Medicaid Services to reimburse for MTWA analysis employing the modified moving average (MMA) approach, which researchers are increasingly convinced yields the more relevant data set.

The lynchpin in this discussion is the perception that most incidents of irregular heartbeat occur during other than a resting state, thus suggesting that an unstressed measurement underestimates a patient's vulnerability. According to CMS's Feb. 14 proposed decision memo, the MMA measurement requires that the patient wear a monitor for 24 hours and can be used while the patient is on a treadmill.

CMS accepted the petition, filed by GE Healthcare (Waukesha, Wisconsin), last August and expects to render a decision by May 14.

According to CMS, the first 13 of the public comments weighed heavily against coverage for MMA testing, citing a lack of evidence to support the idea. One of those in favor acknowledged the need for randomized trials, and the other was "from the same organization as the entity that requested the reconsideration."

CMS said that "many patients have indeterminate results" from T-wave testing and that the data behind the use of MMA "is relatively sparse," citing a study published by Nieminen, et al, in a publication in the British Medical Society's Cardiovascular Disorders in 2006.

The agency deemed the patient pool sizeable, but nonetheless questioned "the discrepancy between the 1,037 subjects in the 2007 study ... and the availability of much more data at the time the study was published." CMS also pointed to the lack of a control group as "a significant methodological weakness."

As a result, CMS proposes to stand pat on the issue, but said it would look at comments "that include new evidence we have not reviewed here." As matters stand, MTWA testing is only reimbursed when conducted with spectral analysis.

CMS launches consumer hospital guide

It's all about quality when it comes to hospitals, and many are of the opinion that when consumers can see how hospitals score on quality points, they'll flock to the best and ditch the rest.

Hence, the Centers for Medicare & Medicaid Services reported last week the posting of a substantial base of survey information at its web site that gives consumers a look at the quality scores of hospitals across the U.S.

Thanks to the information at the site, located at www.hospitalcompare.hhs.gov, Medicare beneficiaries will have access to data on "a number of certain elective hospital procedures provided to those patients and what Medicare pays for those services." CMS said that the site provides "quality information, patient satisfaction survey information, and pricing information for specific procedures" that are essential to making "effective decisions about the quality and value of the healthcare available to them through local hospitals."

Mike Leavitt, the Secretary of the Department of Health and Human Services, said the site will give beneficiaries "more choice about the quality of their healthcare and how they may be able to lower their healthcare costs."

Leavitt also said, "To achieve goals around providing consumers with the information necessary, and the incentive, to choose hospitals based on quality and value, HHS is continuing to work with partners such as the Hospital Quality Alliance to drive quality up and the cost down."

The Hospital Compare site "currently provides information on 26 quality measures, which include process of care and outcome measures," according to the March 28 announcement, with the latest 10 measures giving consumers "a better picture of the quality of care delivered at their local hospitals."

Acting CMS administrator Kerry Weems said in the statement that beneficiaries "tell us ... they want to know what their neighbors are saying about the care they received while in the hospital; they want to know how much it costs; and they want to know about the quality of that care." Weems said that the Hospital Compare site is among the tools the agency is deploying that will help consumers "to do just that."

Upcoming additions to the site include mortality measure for pneumonia and two pediatric asthma measures collected by the Joint Commission on the Accreditation of Healthcare Organizations.