Appropriate Use of Myocardial Perfusion Imaging in a Veteran Population

Abstract

2016-10-17T18:53:41

Impact of Insurance Carrier, Prior Authorization, and Socioeconomic Status on Appropriate Use of SPECT Myocardial Perfusion Imaging in Private Community‐Based Office Practice

“…Second, our study indicates that higher reimbursement for SPECT‐MPI by commercial insurance carriers at the time of the study had no impact on appropriate use rates in this office‐based, fee‐for‐service setting. Our data are consistent with others from the Veterans Administration hospitals showing that lack of financial gains did not prevent high inappropriate use rates . Third, it has been shown that medical care and access to testing tightly correlates with education level, which is closely tied with income .…”

What’s accepted is not always appropriate!

“…This is one of a series of reports from this group on the utility of appropriate use criteria in guiding optimal referral patterns to stress myocardial perfusion imaging. [3][4][5][6][7] In this report, the authors report that there was poor concordance between appropriate use criteria developed by the ACC as compared to the ACR, with a kappa statistic of 0.32-supporting modest agreement between the two statements. As there is no definitive ''gold standard'' for appropriate indications, this finding of modest concordance is reason for caution and pause as to whether variability in practice patterns will be observed.…”

More or less appropriate: The new rule of law for cardiac imaging

“…In practice, discordance would arise, for example, when a provider uses one set of criteria and the insurance provider another. This is one of a series of similar articles from this group [3][4][5] and importantly highlights the challenges in implementation and hurdles in consistent results of appropriateness based on utilization of rating systems from the ACC vs. ACR. But, does this matter?…”

“…Most of the current patient series are referred or retrospective cohorts. [3][4][5][6][7] One may speculate as to whether we need to examine those who are not but should have been referred and how the AUC/AC alter (i.e., improve) clinical decision making on the part of the referring physician. A more detailed evaluation of available population data would be helpful including knowledge of the denominator of appropriate or inappropriate candidates and their course of care.…”