Despite declining use of coronary CT angiographies (CCTA), the amount performed by radiologists has increased since 2013, according to new research published in the Journal of the American College of Radiology.
CCTA is a fairly new imaging modality to assess patients with suspected coronary artery disease (CAD). However, its use is limited when compared to modalities such as radionuclide myocardial perfusion imaging (MPI) and stress echocardiography.
“The vast bulk of CCTA examinations are interpreted by radiologists and cardiologists. In 2007, cardiologists interpreted approximately twice as many of these scans as radiologists,” wrote lead author David C. Levin, MD, of the Thomas Jefferson University Hospital in Philadelphia, and colleagues. “Over the next few years, the decline was seen among both specialties, although it was more pronounced among cardiologists. More recently, the use trends seemed to have stabilized, and cardiologists and radiologists seemed to have arrived at a point of equal involvement by 2013.”
Levin and colleagues sought to assess recent trends in the utilization of CCTA, based on the provider specialty and the place of service, including hospital inpatient facilities, private offices, hospital outpatient departments and emergency departments.
The researchers used the nationwide Medicare Part B Physician/Supplier Procedure Summary (PSPS) Master Files for 2006 through 2016 to determine procedure volumes and utilization rates (per 100,000 Medicare fee-for-service enrollees).
Levin et al. found the utilization rate of CCTA in the Medicare population rose peaked at 210.3 per 100,000 enrollees in 2007. Radiologist usage share was 32 percent in 2007, compared to 60 percent for cardiologists.
The overall utilization rate declined to its lowest point in the study of 107.1 per 100,000 enrollees in 2013. That year, utilization dropped among cardiologist to 38 percent, while radiologists’ usage increased to 58 percent.
The researchers found CCTA in hospital outpatient departments increased substantially after 2010, primarily among radiologists.
From 2007 to 2016, the Medicare office rate among cardiologists dropped by 82 percent. The researchers noted some factors that may have contributed to this substantial decrease—including an unfavorable reimbursement rate for the procedure, the labor-intensive nature of CCTA interpretation, preauthorization requirements, insurance denials, referral bias to traditional radionuclide MPI tests, expenses and lack of referrals, among others.
“In each of these three settings, radiologists now have the predominant role," the researchers wrote. "It thus seems that despite an earlier trend, radiologists have achieved a solid footing in this important aspect of cardiac imaging."
The upturn in CCTA utilization from 2013 to 2016 may be attributed to several factors, the researchers said. Chiefly, many physicians may have become convinced by the literature that CCTA is the preferred initial imaging test when CAD is suspected.
The upturn in CCTA usage has several implications. Training for radiology residents, fellows and technologists must implement more cardiac imaging. The researchers also said providing CCTA coverage “around the clock” will be necessary, especially in emergency departments where patients may present chest pain.
“It seems that after an initial surge in utilization in 2007, followed by a sharp decline through 2013, CCTA use has begun to see healthy growth in more recent years,” Levin et al. concluded. “This trend seems likely to continue with improvements in the technology and increasing recognition of the value of CCTA among referring physicians.”
As a senior news writer for TriMed, Subrata covers cardiology, clinical innovation and healthcare business. She has a master’s degree in communication management and 12 years of experience in journalism and public relations.