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Archive for March, 2010

21st March 2010 saw the passage of healthcare reform bill by the U.S. House of Representatives with President Obama signing on the bill to pass it into law on March 23. For the betterment of the law, the Senate and the House passed an additional healthcare reform legislation on March 25, under budget reconciliation which will be signed by the President on March 30.

But, certain imaging related provisions contained in the bill affects ACR members. These issues are summarised below:

In a non-hospital environment, the utilization assumption rate helps in determining the technical side of reimbursement. This rate for equipments with a cost of $1 million and above is noted to be 62.5 percent in 2010, which will be increased to 75 percent by 2011, according to CMS. It is expected that the rate will increase to 90 percent by 2013. ACR could successfully influence the efforts of the Congress to raise the rate to 90 percent by 2011.

There will be an increase of 50 percent in discount for contiguous body parts by 2011, which is only 25 percent in 2010.

The new healthcare reform law comes as a blow to insurers as it, based on recommendations made by the US Preventative Services Task Force, prohibits insurers from denying coverage for breast cancer screening exams prohibits.

Self-referring physicians would have to inform their patients in writing that the physician/facility will benefit financially from the imaging procedure. The physician/facility should also provide a list of additional imaging facilities from which the patient may receive their imaging services. ACR will work with Congress to demonstrate the need for stricter self-referral guidelines.

The healthcare reform law has the provision for a Center for Medicare and Medicaid Innovation (CMI), aimed at addressing poor clinical outcomes or potentially avoidable expenditures. There is also a suggestion by ACR about linking payments to physicians who order advanced diagnostic imaging services to their adherence to and use of appropriateness criteria for the ordering of such services.

The rule also requires Medicare to reimburse DXA and VFA during 2010 and 2011 and that too at no less than 70 percent of the 2006 rates. This way DXA and VFA will be reimbursed at approximately $98 and $27 respectively.

Though the new law doesn’t repeal or make permanent Medicare’s Sustainable Growth Rate (SGR) formula, there are chances that the deadline for the 2009 SGR rates, which expires on April 5, may be extended until April 30. When the Congress returns from its two week spring recess, there is the likelihood of another bill being considered, which may result in extending the 2009 payment rate deadline until September 30.

Physicians from various parts of the world are serving the survivors of Haiti earthquake by lending their expertise in saving the people. Haiti is slowly recovering from the consequences of the earthquake and some healthcare professionals from Europe and U.S. are arriving to serve the people affected with quake-related injuries, and various other illness such as pneumonia, tuberculosis elc, spread through campings.

A physicians team led by Allen Rothpearl, the Long Island radiologist, is attending the Haitians directly from New York, California and Texas, by reading 20 to 40 digital x-rays a day availing no-charge.

This was made possible through St. Damien’s, a nonprofit pediatric medical center in Haiti whose x-ray suite endured no damage at all during the quake. The builders of the medical center had constructed the radiology room with six-inch thick concrete walls to resist radiation leakage. This was actually done to reduce costs, since the usually used lead sheets for avoiding radiation leakage were very expensive.

The digital x-rays taken from the St. Damien’s reaches Dr. Rothpearl and his team automatically and they responds within an hour. A software is installed converts the x-ray images into digital, stores and finally transmits them to the New York team. The abnormalities, if found, will be alerted to Mr.Reache who supervises the St. Damien’s x-ray operations and he reports it to the physician.

The radiologist team tracked development of Haitian’s health after the quake through these remote readings. They saw mainly fractured and crushed limbs in the first few weeks. The physicians are also observing the physical conditions of the Haitians in the camps, living in the unsanitary and crowded environment.

A new equipment which upgrades the digital radiology software was donated by Dr. Rothpearl. This new equipment boosts the transmission speed and also manifolds the storage capacity of the server.

Recently, a three-month-old baby who suffered from breath shortness was diagnosed by Rothpearl from New York and found out that the child’s lungs were collapsing.

Scientists plan to take-up their concerns, regarding radiation hazards from excessive radiology procedures, to the public on tuesday at a Food and Drug Administration (FDA) meeting, The New York Times reports.

The two-day public meeting (March 30th and 31st) is called by FDA to evaluate the issues regarding unnecessary radiation exposure from routine procedures and to discuss steps devicemakers can take to reduce patient exposure to radiation.

The report states that according to reports from FDA and interviews with the agency scientists, the FDA has ignored warnings from government experts regarding riskes from powerful Computed Tomography (CT) scans used for colo-rectal cancer screening.

Cancer risk from unnecessary radiology diagnostic procedures, doctors prescribing unneccesary scans, lack of standardization of CT scanners and other radiation emitting equipment are all much debated issues nowadays with regard to reducing radiation exposure. Use of CT scans for cancer screening in healthy adults is another hot topic.

The average life time dose of diagnostic radiation has increased around 7 times in the last thirty years. The increasing popularity of CT scans, driven by overzealous doctors and companies, is in particular a cumulative factor for this. The radiation emitted by a single whole body scan is equivalent to that emitted by about 500 conventional x-rays. Studies have showed that CT scans increase the cancer risk by about 0.05 percent.

New York Times reports that it is a very difficult position for the patients side because doctors, patient advocacy groups and manufacturers advocate these tests for their econimic interests; radiologists who own and use equipment favour the tests while patient groups are funded by manufacuters or physician groups.

Also the FDA, who has to sort out the issue, is also divided with internal dispute, the newspaper says. A group of agency scientists might testify that the FDA managers ignored their concerns thereby endangering the public.

Accurate diagnosis of hip and pelvic fractures in the emergency department can speed patients to surgical management, if needed, and reduce the rate of hospital admissions among patients who do not have fractures. Use of MRI in patients with a strong clinical suspicion of traumatic injury but unimpressive X-rays has a substantial advantage in the detection of pelvic and hip fractures.

A study suggests that Virtual colonoscopy or CT colonography can detect malignant cancer outside the colon. According to the study, one out of every 200 people having no symptom of disease possess unsuspected malignant cancer, that too outside the colon.

Colonoscopy is usually done to detect Colorectal cancer, which is supposed to be one of the leading causes of cancer death in U.S. It is recommended to start colorectal cancer screening for people with average risk at the age of 50, but the uneasiness caused by the conventional optical colonoscopy resist people from undergoing screening.

Compared to optical colonoscopy, Virtual colonoscopy has many advantages.

• Less invasive
• Produce detailed image of the interior portion of colon without inserting the scope into it
• The risk of bleeding in the colon, which usually occur with the optical colonoscopy is almost null
• It can be done without sedating the patient
• The structures outside the colon, like pelvis, abdomen and portions of the lungs can be assessed to a limit with this technique. In some cases, virtual colonoscopy is used to diagnose extracolonic parts and most of them appear to be clinically relevant.
• Cost effective
• Saves on time, taking just 10 minutes or less.

The study was conducted by Pickhardt, M.D., professor of radiology and chief of GI Imaging, at the University of Wisconsin School of Medicine & Public Health, and colleagues. For the study, the researchers selected 10,286 adults (5,388 men and 4,898 women) with a mean age of 59.8 years who showed no symptom of the disease. The selected population underwent colorectal cancer screening with virtual colonoscopy either at the University of Wisconsin or at National Naval Medical Center and their medical records were reviewed. It took a mean time 30.2 months for follow-up.

The results showed that 58 patients had unsuspected colorectal cancers, 22 patients had invasive colorectal cancer, extracolonic cancer was found in 36 patients and 31 patients with localized cancers.

Dr. Pickhardt commented,

Although extracolonic evaluation at screening CT colonography does carry some disadvantages, such as patient anxiety, inconvenience, or the potential for benign biopsy, our results suggest that early detection of asymptomatic extracolonic cancer represents an additional benefit of screening CT colonography that is not available with optical colonoscopy. Virtual colonoscopy is an accurate, safe and convenient screening test that could potentially be a life-saving examination.

Amidst the debates and campaigns by the Obama administration to gain support to move forward advancing the healthcare reform bill, Secretary of Health and Human Services Kathleen Sebelius has announced an additional amount of 162 million dollars in the American Recovery and Reinvestment Act (ARRA) for advancement of health information technology (HIT).

The additional funding is to award the states for meaningful use of of HIT and adoption of electronic health records and health information exchange (HIE) . It  will be given to the following 16 states and state designated entities for adoption of HIE according to the national standards:

• Agency of Health Care Administration (FL)
• The Maryland Department of Health and Mental Hygiene
• New Jersey Health Care Facilities Financing Authority
• South Carolina Department of Health & Human Services
• Iowa Department of Public Health
• Idaho Health Data Exchange
• State of North Dakota, Information Technology Department
• State of Alaska
• Nebraska Department of Administrative Services
• South Dakota Department of Health
• Department of Public Health, State of CT
• State of Mississippi
• Indiana Health Information Technology, Inc.
• HealthShare Montana
• Texas Health and Human Services Commission
• Louisiana Health Care Quality Forum

Dr. David Blumenthal, national coordinator for health information technology stated that the grant has now empowered the state to develop innovative ways to overcome the barriers preventing health information exchange.

“States play a critical leadership role in advancing the development of the exchange capacity of healthcare providers and hospitals within their states and across the nation. Health information exchange will enable eligible healthcare providers to be deemed meaningful users of health IT and receive incentive payments under the Medicare and Medicaid electronic health record (EHR) incentive program,”he added.

The funding is part of the 2 billlion effort by the government to achieve meaningful use of HIT and make available the use of electronic health record by each person by 2014.

A new study finds that women who does not undergo annual mammographic screening have higher rate of detection of breast cancer as palpable breast tumors, which are at an advanced stage when compared to cancers detected by mammography screening.

The study supports the benefits of yearly screening mammographyas well as clinical breast examination (CBE) and breast self-examinationat in early detection of breast cancer. Thus it contradicts the new U.S Preventative Services Task Force (USPSTF) recommendations – biennial mammography screening starting at 50yrs, discouraging teaching breast self examination and that current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE).

“Presentation as a palpable mass was more frequent in those women who had not had a mammogram in the prior 12 months. This finding is even more concerning when you consider the recent recommendations for decreasing the use of mammography because it would result in an even greater proportion of breast cancers being detected by palpation and therefore at more advanced stages.”said Judy Boughey, MD, FACS, assistant professor of surgery, Mayo Clinic, Rochester, MN, and a co-investigator of the study.

The study investigator is Dr. Amy C. Degnim, MD, FACS, associate professor of surgery, Mayo Clinic and the findings of the study are published in the March issue of the Journal of the American College of Surgeons.

US President Barack Obama said, its time to stop talking over healthcare reform and start voting for it, and also asked the Congress to vote for the reform.

Obama visited America’s heartland to gather suport from the wavering Democrats for the healthcare legislation. The campaign was a part of the final push in passing the healthcare reform. While Obama was heading to the speech venue, protestors lined the streets waving placards that said, “Healthcare for all,” “Kill the bill,” “Republicans for healthcare reform” and “Say no to socialism.”

In the run to collect support for the healthcare reform bill, Obama and his fellow Democrats accused the heathcare insurance industry for giving importance to profit than to patients.

Obama swore to destroy the waste in the government-run medical programs for the elderly and needy, Medicare and Medicaid.

Obama also accused his critics in scaring the public, saying that the healthcare reform bill would result in reduced access to care elderly people who completely rely on the Medicare.

According to Rainu Kaushal and colleagues from the Weill Cornell Medical College in New York, electronic prescriptions can reduce prescribing errors up to seven-fold. The study, about the benefits of e-prescribing in primary healthcare setting, is published online in the Journal Of General Internal Medicine.

The authors also found that prescribing errors may occur much more frequently in community-based healthcare practices than previously thought.

“At a time when the federal government and many state governments, led by New York state, are pushing for increased use of information technology to improve the delivery of health care, it is important that physicians are aware of how technology like electronic prescribing systems can improve the safety and value of care they give patients,” Rainu Kaushal said.

The authors compared the medication prescribing errors between 15 physicians who adopted e-prescribing and 15 who sticked to the traditional paper-based prescribing, in ambulatory community based practices in the Hudson Valley region of New York, from September 2005 and June 2007.

E-prescribing was done using a commercial, stamd-alone system with clinical decision support system such as dosing recommendations and checks for drug allergies, drug interactions and duplicate treatment therapies.

The primary outcome of the study was prescribing errors. The authors found that there is a seven fold decrease in errors (from 42.5 percent to 6.6 percent during a year) with use of e-prescribing while the error percentage remained high with paper prescriptions (37.3 percent to 38.4 percent at one year).

“Ambulatory prescribing errors rates might be much higher than previously reported,” the study authors conclude. “This is one of the first studies to show that a commercially available, stand-alone eprescribing system is effective in primary care practices, demonstrating a nearly seven-fold decrease in errors.”

Researchers at the Henry Ford Hospital analyzed cardiac computed tomography angiography (CCTA) data from 8, 200 patients and found that people with a family history of coronary artery disease has higher risk of developing obstructive CAD (28 percent) and atheromatous coronary artery plaques than those without a family history.

Cardiac computed tomography angiography (CCTA) is a non-invasive imaging test which uses the CT scanner to image blood vessels of the heart. CCTA can see through the coronary artery and measure the extend of the plaques and CAD.

The Henry Ford Hospital study is the largest one to date using CCTA and the results are presented at the 59th annual American College of Cardiology Scientific Sessions in Atlanta.

“This is the first study to show that family history of premature coronary artery disease is a significant predictor of obstructive coronary artery disease using coronary computed tomography,” says Mouaz Al-Mallah, M.D., director of Cardiac Imaging Research at Henry Ford and lead author of the study.