In a decision that could have gone either way, the Centers for Medicare & Medicaid Services (CMS) announced yesterday that it would not implement a policy that would have restricted reimbursement for coronary CT angiography. The stunning reversal by CMS was a result, in part, of the combined efforts of various societies to effectively oppose the CMS proposal, according to Kim Allan Williams, MD, American College of Cardiology co-chair, in an exclusive interview with Health Imaging News.
Through yesterday’s decision, CMS maintained the status quo that coverage should be determined by local contractors through the local coverage determination process or case-by-case adjudication. All 50 states and the District of Columbia have enacted local coverage determinations for CCTA.
On December 13, 2007, CMS proposed that CCTA fall under the national coverage determination, and requested responses to their proposal. Since the release of this decision, the various cardiovascular societies and associations have responded in varying approaches to inform CMS on the clinical benefits of CCTA, including a multi-society statement, which highlighted the clinical omissions from the initial CMS decision.
In a vote of support, Andrew Whitman of MITA told Health Imaging News that MITA “commend[s] CMS on considering all of the evidence presented to it, and realizing that there is significant support for coverage of CCTA.”
“This decision is something that can be observed in the long-term, because it garnered societies from both sides of the aisle—cardiology and radiology—to work together to alter the path of the CMS,” said Williams, who is also director of nuclear cardiology at the University of Chicago.
Williams said that no one society should take credit for influencing the decision of CMS; however, several took different tactics.
“Some societies within the coalition, such as SCCT [Society of Cardiovascular Computed Tomography] and MITA [Medical Imaging & Technology Alliance] believed it was beneficial to approach Congressional members to optimize exposure to the situation,” Williams said.
MITA worked closely with SCCT and North American Society for Cardiac Imaging (NASCI), ACC, ACR and others, and they showed their commitment to this cause, according to Whitman.
Some society members took a more clinical approach in pointing out through phone calls and email the clinical benefits of CCTA in diagnosing patients with CAD.
“The cross-industry effort to put facts and information on the table, as well as many of the lobbying efforts, were very influential in producing this positive result. Everyone involved can also be proud of what they were lobbying for – better patient access to care that reduces the invasiveness and increases the confidence of diagnoses around the heart,” Gene Saragnese, vice president and general manager of CT and molecular imaging at GE Healthcare, told Health Imaging News.
In response to advocacy efforts, approximately 80 members of the U.S. House of Representatives sent a letter to CMS urging them to reconsider the proposed national coverage determination, while at least a dozen U.S. Senators sent individual letters to CMS expressing their concerns. Both SCCT and MITA praised the yesterday’s decision of CMS.
“We worked with closely CMS to present all the evidence. We obviously thank the members of Congress, who were very concerned about this proposed decision, which had a component to it. However, we worked closely with CMS, and brought CCTA experts from all over the country to show evidence that has been published, as well as evidence that is in the pipeline to be published to show that the value of the test,” Whitman said.
The CMS final decision memo issued yesterday notes that “the use of CTA has increased over the years due to advances in the technology and rapid diffusion of the machines outside the hospital settings. The initial single-slice CT machines produced poor quality images. In the late 1990s, 4-slice CT machines were introduced, with 16-slice and 64-slice CT machines following shortly afterwards. Image quality and performance reportedly increased with each model. However, questions remain on the indications for use.”
Williams does not view this final statement as an ominous sign for the future of CCTA coverage. In fact, he said “it is actually true that questions remain.”
“While CCTA has a proven benefit, it’s still a technology in development. Until the modality