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Leading the News
White House Calls for Imaging Preauthorization in Budget Plan
The Obama Administration has released a fiscal 2010 budget for Congressional approval that assumes a reduction to Medicare imaging utilization costs of $70 million over the next five years and $260 million over the next decade through the use of prior authorization by radiology benefit managers. This savings plan is based largely on recommendations made in a 2008 Government Accountability Office (GAO) report that identified outpatient MRI, CT, and other advanced-imaging modalities as the fastest growing component of physician services covered by Medicare and concluded that prior authorization could be used successfully to reduce costs. However, several organizations representing radiologists have voiced concern over whether prior authorization is an appropriate measure to manage Medicare imaging utilization. The American College of Radiology (ACR) would rather see future legislation call for the use of appropriateness criteria in an order entry system to examine cost and appropriateness issues concerning medical imaging, not radiology benefits managers, says ACR director of public affairs Shawn Farley. Additionally the Medical Imaging & Technology Alliance (MITA) has expressed concern that the use of benefits managers could undermine access to imaging services and could impose an excessive administrative burden on the Centers for Medicare and Medicaid Services. MITA has also raised questions over the validity of the GAO report, which had been questioned by the Department of Health and Human Services for its lack of independent data to certify the effectiveness of radiology benefit managers to reduce imaging costs.
From "White House Calls for Imaging Preauthorization in Budget Plan"
Diagnostic Imaging (02/09) Abella, H.A.
Research
Dose Escalation of IMRT or Brachytherapy Benefits Patients With Intermediate-Risk Prostate Cancer
Dose escalation of intensity-modulated radiotherapy (IMRT) or permanent transperineal brachytherapy (BRT) alone or combined with conventional-dose 3-dimensional conformal radiotherapy (3D-CRT) may help improve biochemical control in patients with intermediate-risk prostate cancer, according to a recent study. The research was presented by Dr. William Wong of the Radiation Oncology Department, Scottsdale, Ariz., at the American Society of Clinical Oncology 2009 Genitourinary Cancers Symposium. Over the course of the study, Wong's team evaluated the effects of dose escalation in 270 patients who received treatment with 3D-CRT, 314 who received high-dose IMRT, 225 who received BRT, and 44 who received external-beam radiation plus a BRT boost (EB+BRT). Researchers found that at the median follow-up time of 58 months, the biochemical control rate for the 3D-CRT group was 74 percent, compared to 87 percent for IMRT, 94 percent for BRT alone, and 94 percent for EB+BRT.
From "Dose Escalation of Intensity-Modulated Radiotherapy or Brachytherapy Benefits Patients With Intermediate-Risk Prostate Cancer"
Doctor's Guide (03/01/09) Brauser, Deborah
Technology
Researchers Use MDCT to Improve Surgical Protocol Planning for Patients With Pancreatic SPTs
Shanghai Jiao Tong University Prof. Wang DB and colleagues recently used multi-detector row computed tomography (MDCT) to image solid pseudopapillary tumors (SPTs) of the pancreas. Their findings, reported in the World Journal of Gastroenterology, detected a number of imaging features of pancreatic SPTs on MDCT that may be suggestive of the malignant potential associated with aggressive behaviors. For example, the researcher found when the size of the tumor was 6 cm or greater, the possibilities of vascular and capsular invasion increased significantly. The researchers suggest that the imaging findings of MDCT could be beneficial to patients' surgical protocol planning.
From "Do Imaging Findings Imply Malignant Potential at Multi-Detector Row Computed Tomography"
Medical News Today (02/24/09)
Experts Predict Increase in Utilization of SPECT/CT
Combination single photon emission computed tomography (SPECT)/CT has become increasingly popular compared to dedicated stand-alone SPECT systems. Supporters of SPECT/CT say the systems can be useful for a number of clinical applications, including characterizing bone scan lesions and for attenuation correction and calcium scoring in cardiac imaging. However, some radiologists also note that SPECT/CT can create workflow problems, as SPECT studies tend to take significantly more time than traditional CT scans.
From "Sizing Up SPECT/CT"
Advance (02/19/09) Hatfield, Scott
Study Utilizes First-Pass IV Gadofosveset-Enhanced MR Angiography to Image Pedal Arteries
A study of first-pass IV gadofosveset–enhanced MR angiography to visualize pedal arteries in patients with peripheral arterial occlusive disease found that it provided good diagnostic utility in 83.9 percent of segments, with no venous contamination in 96.8 percent of segments. The angiography used a dedicated foot coil and cuff compression, assessing arterial segments for visibility, stenosis or occlusion, and contamination. Switzerland's University Hospital Basel researchers concluded that "Gadofosveset-enhanced MR angiography of the pedal arteries in patients with peripheral arterial occlusive disease has arterial visibility equal to that of digital subtraction angiography and facilitates depiction of clinically significant stenosis and occlusion."
From "Pedal Angiography in Peripheral Arterial Occlusive Disease"
American Journal of Roentgenology (02/01/2009) P. 775; Kos, Sebastian; Reisinger, Clemens; Aschwanden, Markus
Medical-Legal Issues
CMS Predicts Reduction in National Health Expenditures in 2009 due to Recession
A report issued by the Centers for Medicare & Medicaid Services (CMS) projects that growth in U.S. national health expenditures (NHE) in the United States will significantly overtake economic growth in 2008 and 2009 because of the recession. NHE growth is expected to be 6.1 percent in 2008 as health spending increases from $2.2 trillion in 2007 to $2.4 trillion, while 2008 gross domestic product (GDP) growth is expected to be 3.5 percent. Health spending is projected to rise 5.5 percent while GDP is expected to decline 0.2 percent in 2009. NHE growth is expected to decrease to 4.6 percent in 2010, primarily due to a projected decline in Medicare spending growth principally attributable to a 21 percent cut to Medicare physician payment rates required under the Sustainable Growth Rate (SGR) formula called for in 2010 under current law. Spending on physician and clinical services is expected to grow 6.2 percent in 2008, compared to a 2007 growth rate of 6.5 percent. A deceleration in hospital spending growth is forecast from 7.2 percent in 2008 to 5.7 percent in 2009, resulting from reduced growth in use affiliated with the recession and projected slower income growth. A slowdown in prescription drug spending growth to 3.5 percent is expected in 2008, followed by an acceleration to 4 percent in 2009 as projected double-digit increases in Medicare and Medicaid growth compensate for continuing recession-related deceleration in private prescription drug spending growth.
From "Growth in National Health Expenditures Expected to Slow in 2009 as a Result of Recession"
Centers for Medicare & Medicaid Services (02/24/09)
Administration Proposes Medicare Cuts, Tax Increases Pay for New Healthcare Plan
President Barack Obama plans to fund the revamping of the U.S. healthcare system with $634 billion generated from higher tax revenues from wealthy Americans and cuts in Medicare spending over the next decade. The money will be used to help provide health coverage to more than 47 million uninsured Americans. The president's budget plan proposes that the top income tax rate for couples with incomes of more than $250,000 a year be raised from 35 percent to 39.3 percent. The plan also would limit tax deductions for the wealthy. These tax changes are expected to generate about $318 billion over the next 10 years. At the same time, about $316 billion will be cut from Medicare by decreasing some payments to private insurance plans that focus on the elderly. Also under consideration is a higher premium for Medicare prescription drug coverage for upper-income beneficiaries.
From "Medicare Cuts, Tax Hike on Wealthy to Pay for Healthcare Plan"
Los Angeles Times (02/25/09) Levey, Noam
Clinical Practice
Declining Mammography Rates Portend Potential Preventive Care Crisis
A recent report by the Centers for Disease Control and Prevention (CDC) indicates that mammography screening rates fell between 2005 and 2006. The report, published in the American Journal of Roentgenology, analyzed mammography screening utilization rates by state in correlation with each state's breast cancer incidence rates. Between 2000 and 2006, 49 states saw a reduction in breast cancer incidence, while 17 has a slight increase in mammography screening rates. However, 34 states as well as the District of Columbia saw a decline in screening rates during that time period, leading to an overall screening utilization decline for women 40 years of age and older. A commentary on the CDC report by University of Michigan professor of radiology Dr. Ruth C. Carlos voices concern that this reduction in screening rates could lead to a future increase in breast cancer incidence rates. According to Carlos, both health insurance coverage rates for mammography and the number of breast imaging centers in the United States are falling, which may be leading to the drop in screening rates.
From "Declining Mammography Rates Portend Potential Preventive Care Crisis"
Diagnostic Imaging (02/09) Abella, H.A.
U.S. Preventive Services Task Force Recommends Dual Energy X-ray Absorptiometry for Osteoporosis Diagnosis
Approximately 8 million women and 2 million men in the United States suffer from osteoporosis. Injuries and mortality linked to the disease can be prevented with early screening and treatment. The U.S. Preventive Services Task Force recommends using dual energy x-ray absorptiometry to screen all women 65 years and older as well as women ages 60 to 64 who have increased fracture risk. Other organizations recommend screening all men 70 years and older. For persons with osteoporosis diagnosed by dual energy x-ray absorptiometry or previous fragility fracture, effective first-line treatment consists of fall prevention and adequate intake of calcium (at least 1,200 mg per day) and vitamin D (at least 700 to 800 IU per day) as well as treatment with a bisphosphonate. Raloxifene, calcitonin, teriparatide, or hormone therapy are also recommended for some patients.
From "Diagnosis and Treatment of Osteoporosis"
American Family Physician (02/09) Vol. 79, No. 3, P. 193; Sweet, Mary Gayle; Sweet, Jon M.; Jeremiah, Michael P.
Industry News
Studies Examine the Impact of Scan Quality on Imaging Costs
Medical imaging is now a $100-billion-a-year industry in the United States, with Medicare paying for $14 billion of that. However, recent studies claim that as many as 20 percent to 50 percent of the procedures should never have been done because their results did not help diagnose ailments or treat patients. Some medical observers say that bad scans are part of a growing problem with medical imaging, due in part to the fact that insurers do not distinguish between scans that are done poorly or done well or read by less- or more-qualified doctors. Dr. Gary Glazer, the chairman of radiology at Stanford, says technology has advanced so much that [an] older scanner "is not the same machine." Imaging centers can gain accreditation from the American College of Radiology, but some centers are not accredited, although the percentage is not known because there is no national registry of imaging centers. However, new Medicare rules that go into effect in 2012 will result in Medicare only paying for scans done at accredited centers. “The studies I see coming from the outside vary from marginal quality to very good quality,” says Dr. Chris Beaulieu, a Stanford radiology professor, who notes that interpretation can be crucial. “A good radiologist can sometimes accurately read scans off of a lower-quality scanner,” he says. “I see that all the time."
From "Good or Useless, Medical Scans Cost the Same"
New York Times (03/02/09) Kolata, Gina
RSNA Weekly is a briefing of the latest radiology-related news selected from hundreds of sources by the editors of Information, Inc. While care is taken to use good sources, inaccuracies in source material are not the responsibility of RSNA or Information, Inc.
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