Diagnostics & Imaging Week Washington Editor
WASHINGTON — As the 109th Congress fades into history, the stakeholders in the various budget battles either can claim success and lay down their arms or, if having failed in the fiscal feud, gird themselves to fight another day.
An event held in the nation's capital, titled "Medical Imaging: Transforming Cardiovascular Care," featured elements of science and also commemoration of the history of medical imaging.
But, in the main, it was about the money.
Panel moderator Morton Kondracke, executive editor of the Capitol Hill daily Roll Call said that "the imaging revolution is in danger of being inhibited" due to the cuts to Medicare imaging as a result of the Deficit Reduction Act (DRA) of 2005.
Congress passed on the opportunity to remedy those impending cuts in its end-of-session activity, despite having acted on the so-called Part B doc fix.
Kondracke said that imaging may cost the Centers for Medicare & Medicaid Services a substantial sum but that imaging technologies save "millions of dollars more" by catching diseases early on, when treatment is less expensive and outcomes are better.
Kondracke maintained that imaging technology development may also suffer in this fiscal environment. "The research itself is curtailed if the companies involved don't think they'll sell the machines," he noted.
The legendary William Devries, MD, who has single-handedly pioneered perhaps more advances in heart care than any other researcher, was on hand at the event to argue that "nothing has truly transformed medical care like imaging."
He pointed out that heart disease typically surfaces in men and women between the ages of 50 and 60, and that "these people are in the economic primes of their lives." He described this population's recovery from treatment for advanced-stage heart disease — primarily consisting of "lying in a hospital bed for two weeks, [and] taking a month to recover" — as a "huge waste."
DeVries, who serves as a clinical professor of surgery at the George Washington University Hospital (Washington), added that "life expectancy in this country between 1950 and now has increased 20 years," an improvement for which he was not bashful in assigning credit.
"Medical imaging is singularly (but not solely) responsible for these improvements," he said.
Allen Taylor, MD, director of cardiovascular research at the Walter Reed Army Medical Center (Washington), spoke on behalf of the American College of Cardiology (Washington) and said that medical imaging "is one of the great developments in the past 1,000 years."
Taylor said that "the central message here is that medical imaging is good medical practice," and is cost-effective, but that "cost-effectiveness is tough to define" because medical imaging "is so central to what [diagnostics] do."
Taylor said that the cost-effectiveness equation used by Congress and CMS to trim Part B imaging services is faulty because "you can't overestimate the cost of invasive surgery" if the calculation fails to include the concomitant disability, lost income for the patient, and the cost of recuperation. Diagnostic imaging can reduce the use of diagnostic catheterization and stress tests as well. He insisted: "We absolutely need our imaging."
Taylor said his argument was not for unrestrained use of medical imaging but rather for measurements to ensure that "it is done in a quality way and in appropriate circumstances."
On the other hand, defining those circumstances is no easy task, and the ACC continues to address standards for imaging in concert with several other organizations, including the European Society of Cardiology (Sophia Antipolis, France).
"The government should not care what imaging costs so long as it is used appropriately," Taylor flatly stated, adding that "the controversy over medical imaging must go away."
In the Q&A session, Andrew Whitman, VP of the National Electrical Manufacturers Association (Rosslyn, Virginia), sponsors of the event, said that the reduction in Medicare outlays will primarily affect imaging performed in doctor's offices, adding that the cuts are "based on a misperception that imaging is overused." He predicted "a major decline in imaging in physician's offices" and said that "the policy was put into effect without adequate data."
Kondracke posed the question of whether defensive plays a role in boosting imaging use. DeVries responded: "I think that many times a scan might not be indicated" but a physician may opt to prescribe a scan despite the absence of a clear need.
"It's not right and the patient has to pay . . . for the physician's [legal] comfort," he noted, but he said that professional societies have a role to play in giving practitioners an external rationale for skipping a diagnostic procedure.
"If you're practicing medicine not to get sued, that's a problem and that physician is a bad physician," DeVries said, commenting further that such behavior is often prompted by previous legal experience.
Taylor told Diagnostics and Imaging Week that CMS "did not look at reimbursement on invasive procedures" when examining the value of diagnostic imaging, but he acknowledged that CMS and Congress are not in a position to look at cost-benefit data for disease-specific treatments in isolation.
In response to the idea that doctors and patients are inordinately fond of diagnostic imaging due to the lack of co-pays, Taylor said, "You may see co-pays emerge" should payers conclude that the absence of a co-pay feeds demand.