MedSolutions’ Outcomes-Focused Cardiac Imaging (OFCI) could protect access to needed services while generating significant savings for Medicare. Implementing a cardiac imaging benefit management program, like those used in the private sector, could help the Centers for Medicare and Medicaid Services (CMS) avoid reimbursement cuts that may drive many cardiologists and other specialty physicians out of business, said executives with MedSolutions, a Franklin-based provider of medical cost management services.

 

The use of cardiac imaging management would limit spending by ensuring the appropriate use of diagnostic imaging tests, which represent a major cost center for CMS. Under the 2010 CMS Physician Fee Schedule, reimbursement for cardiology services — including in-office diagnostic testing — would be cut by up to 40 percent. According to the American College of Cardiology (ACC) and other industry groups, which have filed suit against the CMS, the changes would limit access to life-saving testing and services currently available in cardiology practices and force many patients to seek outpatient care at hospital facilities where costs are up to five times higher.  

 

“At a time when the demand for cardiology services is projected to grow by 60 percent over the next two decades, the proposed cuts have the potential to limit access to critical diagnostic testing for many seniors — especially those in rural and inner-city areas,” said Curt Thorne, CEO of MedSolutions. “Instead of paying doctors less to perform these tests, CMS should consider front-end measures — such as cardiac imaging management — to ensure the patient is getting the right test in the first place.”

 

MedSolutions’ Outcomes-Focused Cardiac Imaging (OFCI) program uses evidence-based guidelines and trained medical professionals to ensure patients receive the right test at the right time, thereby increasing the accuracy of diagnosis and timeliness of treatment. Increased focus on appropriate utilization is important as Medicare spending on imaging continues to grow at an alarming rate, topping $14 billion annually.

 

Cardiac imaging, including procedures performed in physician offices, has also seen significant growth. According to a Medicare Payment Advisory Commission report, spending on cardiac imaging is increasing at nearly double the rate of other medical procedures. The American Heart Association estimates the overall cost of heart disease to reach $503 billion in 2010; an increase of $54.5 billion since 2008 and $27.7 billion since 2009.

 

“Cardiac studies are the fastest growing type of imaging, yet research indicates that one in five nuclear heart scans are unnecessary … at a cost of $2,000 per scan,” saidGregg Allen, MD, chief medical officer of MedSolutions. “Cardiac Imaging Management not only protects patients from unnecessary and significantly dangerous radiation exposure but also ensures that tests meet the quality standards necessary to yield an accurate diagnosis.”

 

“While the CMS should be commended for its cost-cutting efforts, limiting the ability of physicians to offer these life-saving tests to patients is not the answer,” said Thorne. “Instead, we urge the CMS to evaluate the role Cardiac Imaging Management could play in preventing wasteful — and potentially harmful —overutilization that translates to billions in unnecessary expenditures each year.”