Local, State, Federal

Radiologists Say No to National Health Policy
CMS Continues Coverage of CCTA

Radiologists Say No to National Health Policy

While results of a recent poll revealed that more physicians in 2007 supported the creation of government-financed national health insurance than in 2002, only 30% of the radiologists surveyed said they backed national coverage.

Of the 2,193 physicians who participated in the survey, radiologists represented the lowest percentage of polled specialists in favor of a national policy.

“There really is no way the [American College of Radiology] could say with any certainty why the doctors who were surveyed responded positively or negatively regarding national health insurance,” said ACR spokesman Shawn Farley, to AMNews.

According to the report, which was published in the April 1 issue of Annals of Internal Medicine, 59% of physicians surveyed supported the creation of “national health insurance” with a main goal of “financing health care for all US citizens.” These most recent numbers indicate a 10% increase, compared to a previous poll in 2002. Nevertheless, physician organizations said their members’ support of a national policy could not be equated with support for single-payor health care.

Additionally, 55% of physicians supported “achieving coverage through more incremental reform,” a topic that had not been addressed in the 2002 survey.

“Across the board, more physicians feel that our fragmented and for-profit insurance system is obstructing good patient care, and a majority now support national insurance as the remedy,” said survey coauthor, Ronald T. Ackerman, MD, MPH, associate director of the Center for Health Policy and Professionalism Research at Indiana University.

Edward L. Langston, chair of the AMA Board of Trustees, points out that respondents may have experienced confusion over the survey’s terminology; therefore, it is difficult to draw conclusions from the report. “The study does not define national health insurance or incremental reform, both of which can be interpreted in a variety of ways,” Langston said.

The highest percentage among polled specialists who supported national health insurance went to psychiatrists, coming in at 83%—a figure up from 64% in 2002.

The AMA said it is in favor of covering the uninsured through the distribution of tax credits or vouchers to individuals and families, based on income.

It also calls for the expansion of health plan choices, more unified regulation of health insurance, guaranteed policy renewals, an individual insurance mandate for those earning more than 500% of the federal poverty level, and subsidies for high-risk enrollees.

The American College of Physicians endorsed single-payor health care last December as one of two preferred health reform options, according to the AMA. It also supports a public-private system that guarantees access to health coverage and subsidizes the coverage of lower-income Americans.

The study was coauthored by Aaron Carroll, MD, director of the Center for Health Policy and Professionalism Research at Indiana University and a board member for Physicians for a National Health Program, a single-payor advocacy organization that was not involved in the study.

CMS Continues Coverage of CCTA

The Centers for Medicare and Medicaid Services (CMS) announced in March that they would continue coverage of coronary computed tomography angiography (CCTA) through the Local Coverage Determination process and forego the proposed creation of a National Coverage Determination.

This decision follows CMS’ initial proposal in June of last year that called for a National Coverage Analysis, possibly limiting coverage to tightly restricted instances where CCTA was performed as part of an ongoing clinical study. These indications included symptomatic patients with chronic stable angina or anginal equivalent and an intermediate pretest probability of coronary artery disease (CAD), and symptomatic patients with possible acute coronary syndrome, a low risk of short-term death, and an intermediate probability of CAD.

“Proponents of the imaging procedure believe that coronary CTA may reduce the need for invasive coronary angiography for certain patients,” the report stated. “However, others have noted a lack of evidence on outcomes and limitations in the technology, including segments that may be uninterpretable and health risks from the radiation exposure.”

Several societies, including the American College of Radiology, responded with their strong opposition to the proposal. They published a joint release in January that pointed to the limited validity of the evidence on which CMS based its draft policies and drew attention to newer research and data that demonstrated CCTA’s importance. US lawmakers, from both the Senate and the House of Representatives, joined in the effort, sending CMS letters that urged it to reconsider the proposed NCD with Coverage with Evidence Development (CED).

According to CMS, it received 670 comments during the public comment period following the proposal. Only 10 commenters agreed with the proposed decision to use Coverage with Evidence Development, while 649 commenters opposed. The remainder provided no clear direction for coverage, CMS reported.

Nevertheless, in its decision, CMS maintained that there is an uncertainty regarding the potential health benefits from including CCTA in the diagnostic workup of patients who may have CAD, and that no “adequately powered study has established improved health outcomes attributed to CCTA.”

“However, while public comments and specialty society opinions following the CMS proposed decision to use CED did not dispel the uncertainty of the test’s clinical utility, they did strongly favor maintaining the local coverage policies for CTA,” the report concluded. “In light of this, CMS has decided to make no change in the current NCD.”

In related news, a multicenter study presented at the 57th annual meeting of the American College of Cardiology in Chicago demonstrated CCTA as a cost-saving, noninvasive imaging procedure for patients with suspected coronary artery disease.

Led by cardiologist James K. Min, MD, the study examined the cost savings of two leading noninvasive methods for detecting CAD. Results revealed that imaging of patients who underwent CCTA without prior diagnosis of CAD amounted to $603 less per patient, compared to those who underwent myocardial perfusion imaging (MPI or SPECT). According to researchers, both groups had equal clinical outcomes.

“CCTA has become a standard of care for diagnosing and treating cardiac disease throughout the country and the world,” said Andrew Whitman, vice president of the Medical Imaging & Technology Alliance. “Studies like these remind us why it is crucial that policymakers turn to results-based findings and permit continued access to this state-of-the-art diagnostic tool for heart disease patients nationwide. Medical imaging works for patients by facilitating better diagnoses and works for health care providers by reducing costs.”

Medicare local coverage determination policies in all 50 states and the District of Columbia support coverage of CCTA. Aetna, Humana, United Health Group, and 14 Blue Cross Blue Shield carriers also provide coverage of the noninvasive procedures.