Justine Cadet, Executive Editor

Appropriately and uniformly integrating nuclear cardiology technologies into the patient care continuum is being challenged by government changes and practice variations.

In addition to the 36 percent cut in SPECT imaging reimbursements for independent cardiovascular practices, the Medicare Payment Advisory Commission (MedPAC) now is recommending additional reduced reimbursement, payment bundling and prior authorization for medical imaging services.

Specifically, in the nuclear cardiology space, MedPAC proposed that the Relative Value Scale Update Committee (RUC) and CPT Editorial Panel expand efforts to create codes and suggested that the groups consider:

• Creating bundled codes that include different types of services that are frequently performed at the same time, such as nuclear medicine studies and cardiovascular stress tests or evaluation and management services and certain diagnostic tests; and
• Combining radiopharmaceuticals with their associated imaging services (e.g., packaging myocardial perfusion imaging (MPI) studies with their related radiopharmaceuticals), as is done in the outpatient prospective payment system.

Even prior to the implementation of such proposed changes, practices are exhibiting disparate practice patterns of gender disparities, despite widely distributed appropriate use criteria (AUC) to help guide MPI use in women. A study published in the Journal of Nuclear Cardiology showed that the vast majority of inappropriate MPI studies were ordered in women by primary care physicians.

In the study, Gupta et al applied AUC  to 314 MPI imaging studies to assess possible gender disparities. Of the 314 studies, 263 were deemed appropriate, 34 were deemed inappropriate and 17 were uncertain. The researchers found that 68 percent of the inappropriate studies and 82 percent of uncertain studies were performed in women.

Yet, nuclear cardiology technologies continue to gain utilization in various provider settings and physicians uncover new patient conditions where it may prove valuable. For instance, electrophysiologists are discovering that PET and PET/CT may help guide EP ablation procedures and aid in pre-procedural planning. 

Also, separate studies showed that a new PET tracer may lead to better CAD detection and SPECT imaging technology may lead to better detect ischemic heart disease in diabetics.

If you have insight as to how your practice is digesting all the clinical data and employing nuclear cardiology technologies, while confronting stricter Medicare policies let us know.

Justine Cadet jcadet@cardiovascularbusiness.com