Roundtable | PCI Imaging: Before, During and After

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CVB040101Physicians are under constant pressure to provide quality care using the latest evidence-based medicine, reduce overhead costs amidst declining reimbursements and remain competitive with the latest technologies. Cardiovascular Business invited a group of interventional and diagnostic cardiologists to discuss the latest practice and imaging trends that support a busy cath lab.

Listen to the discussion

Participants of the discussion are:
AnselGary Ansel, MD, an interventional cardiologist with MidOhio Cardiology and Vascular Consultants, and director of the Center for Critical Limb Care at Riverside Methodist Hospital in Columbus, Ohio.
GallowayJoe Galloway, MD, an interventional cardiologist from Inland Cardiovascular Associates in Spokane, Wash.
GreenStephen Green, MD, chief of cardiology, associate director of the cath lab, associate chairman of the department of cardiology and director of performance improvement for cardiac services at North Shore University Hospital in Manhasset, N.Y.
HirschRussel Hirsch, MD, director of the cardiac cath laboratory at the Heart Institute at Cincinnati Children's Hospital, Ohio.
ThomsonLouise E. J. Thomson, MBChB, a physician in cardiac imaging, and director of cardiac MRI, at the S. Mark Taper Foundation Imaging Center, Heart Institute, Cedars Sinai Medical Center in Los Angeles, Calif.
C.P. Kaiser, Cardiovascular Business

What can practices and hospitals do to stay solvent as the new Medicare reimbursement cuts take effect this month?

Green: From my standpoint, as chief of the department, and particularly concerning my imaging staff, I have to ensure that they practice as efficiently as possible. For example, during the workday, the digital echo images are dropped into the reading network. The sonography techs electronically enter patient data directly to the electronic reporting system based on their scans. The active readers can then review the images as well as the tech-generated preliminary reports and finish the reports online, without transcription. The reports are then placed into the result section of the patient’s EMR.

During off hours, our fellows or attendings drop the digital emergency studies into the network. Our on-call echocardiographer can then download them to a laptop, where the images can be reviewed and a report generated remotely to the patient’s EMR. In this way, the overall process of image analysis and report generation is streamlined to optimize efficiency. Echocardiographers are therefore more able to focus on quality of interpretation and educational activities for the ultrasonographers and cardiology fellows.

Thomson: The challenge for noninvasive cardiologists is to ensure that the tests we are performing are appropriate. The challenge for all of us is to use these resources wisely. What we don’t want to see happen is imaging practices trying to increase volume to maintain their revenues, because that will just make the situation worse.

Galloway: We have several outpatient imaging centers around Spokane that may need to consolidate if they can’t pay for the square footage. I also am concerned that the nuclear, vascular and echo diagnostic services in rural areas may not be utilized to the fullest potential, creating a scenario for some to be discontinued.

In our physician-owned outpatient cath lab, our technical reimbursement is about $1,250 for a left heart cath, which is quite a bit less than what hospitals receive. With the new cuts, that reimbursement will decrease to about $1,000, which barely allows us to break even.

Ansel: It will be interesting to see what happens in smaller communities. In Ohio, the CON [certificate of need] just went down a few years ago, so even smaller hospitals have a cath lab. With these reimbursement cuts, that business plan doesn’t appear to make sense anymore.

Hirsch: The cuts won’t affect pediatric intervention as much as they will impact noninvasive imaging, particularly transthoracic echo with respect to color flow Doppler.

What techniques or protocols do you use to reduce radiation dose exposure?

Ansel: I’m concerned not only for patients, but also for our staff. We employed several tactics. We had our radiation physicist check our shielding and found some incorrect assumptions. Some of us also use extra shielding, which dramatically decreases the radiation dosage to the operators. And we’ve educated our operators to change the angles to reduce the risk of radiation dermatitis.

Green: In general, American cardiologists seem