A new health policy statement on the use of noninvasive cardiovascular imaging was released Feb. 17 by the ACC and published in the Journal of the American College of Cardiology. The statement, which was also endorsed by 14 other medical societies, discusses the current understanding about the patterns and drivers of imaging use, along with patient safety and test quality, and notes that a more patient-centric approach to guiding appropriate use is needed than payer-driven reimbursement reductions and prior authorization requirements.

For years medical imaging has served as an exemplary example of scientific understanding revolutionizing the diagnosis and treatment of disease. Without the risks of surgery or other invasive procedures physicians can peer directly into the body to gain insight into the structure and function of any organ. Current cardiovascular imaging methods, including echocardiography, nuclear cardiology, cardiac computed tomography, and magnetic resonance imaging are all now routinely employed for their diagnostic assistance.

Such a significant growth in their rate of use however, has coincided with an equally growing national concern about the rate of medical spending in the U.S. Contending that policy makers must take account of the complex interplay between medical care quality – of which proper use of diagnostic testing is an integral part – patient health outcomes, and medical costs, the ACC has provided an exposition of the issues involved and the possible ways in which the medical care system can balance responsible use of imaging with patient safety concerns while maintaining or even enhancing quality of care.

Specifically, the health policy statement warns against more "simplistic causal models" that connect reimbursement with utilization, which can lead to bad policies that inevitably harm patients. The statement also advocates for the use of both randomized trials and clinical registries, which could be used to provide the needed information on patient outcomes, resource use and medical costs. Implementing electronic medical records could also promote the efficient use of point-of-care tools such as appropriate use criteria and decision support systems, and combine patient-specific information with statistical models.

It also identifies the role physician groups play in promoting appropriate imaging use. For example, the ACC's Imaging in FOCUS initiative pairs local chapters with health plans to reduce geographic variation in imaging use and lower the rate of “rarely appropriate" tests.

"The current situation in non-invasive cardiovascular imaging is pretty much unsatisfactory from everyone's point of view," says Daniel B. Mark, MD, MPH, FACC, professor of medicine at Duke University School of Medicine, director of outcomes research at the Duke Clinical Research Institute, and the chair of the statement's writing group. "However, it is encouraging that we now have much more knowledge and several new informatics tools that can be used to help us apply that knowledge. We have many of the ingredients needed to create a more responsible, cost-conscious approach to imaging that still preserves – at its core – patient-physician decision making."

"What we need is a convergence of will to make [responsible imaging use] happen from all key stakeholders. This statement hopefully is a step in that direction," he adds.

Keywords: Electronic Health Records, Health Policy, Outcome Assessment, Health Care, Registries, Societies, Medical, Decision Making, Tomography, X-Ray Computed, Cardiology, Diagnostic Imaging, Patient Safety, Magnetic Resonance Imaging, Echocardiography