There are some technologies that will forever change the way medicine is practiced. CT scanning is one of them. There is hardly an area of medicine that doesn’t benefit from the information gleaned from a CT scan. But its reputation has suffered of late due to its much-reported overuse, in addition to the high single- and/or high cumulative-scan radiation dose exposure to the patient.
Vendors and practitioners have for the last several years devoted much research to help reduce the radiation dose from single scans. It is possible today with certain technology and protocols to image the coronary arteries with less than 5 mSv.
Some payors also have enacted protocols that alert them when a patient has reached a threshold in terms of the number of scans or the amount of radiation dose exposure. The National Institutes of Health recently mandated that all CT and nuclear medicine imaging at its Clinical Center track patient dose and incorporate those data into the EMR. The FDA held a meeting earlier this year in which it petitioned feedback from vendors and practitioners in an effort to learn more about radiation dose exposure. We’ll have to wait and see if and how deeply the FDA gets involved with implementing and enforcing changes to better regulate patient exposure from medical imaging (see Cover Story, page 4).
One long-standing, game-changing technology is drug-eluting stents (DES). According to a recent study, the introduction of DES has changed the way medicine is practiced. More tests are done to find more candidates for DES, and the real economic impact is almost double the projected impact (see page 14). The study points out that more than half of Medicare spending on DES comes from implanting them into patients with stable disease, an off-label indication. The same study notes that the contrary is true for ICDs, that their projected financial impact is in line with real spending.
While e-prescribing is not new, the push from CMS to have all facilities e-prescribing within four years is—and that deadline has many practitioners concerned (see page 8). CMS has offered incentives and penalties for those who meet and do not meet a certain threshold of e-prescribing by certain, scheduled dates. Even proponents of e-prescribing say that CMS’ timeline is unreasonable.
While perhaps not a game-changer yet, intravascular ultrasound (IVUS) is gaining momentum as a technology that is vital to improving outcomes—and payors have taken note (see page 12). IVUS is particularly sensitive to helping ensure the proper placement of DES, which in turn can help reduce in-stent restenosis, late stent thrombosis and the need for revascularization—all of which take a financial toll on the healthcare system.
We clearly need new technology, but we also need to ensure that medicine is practiced safely and economically.