CMS Okays Heart Scan Payments

I suspect there will be a lot more of these decisions over the next nine months as Bush administration appointees hoping to line up their next jobs grant top-of-the-wish-list favors to special interests.

The New York Times website reported Wednesday that the Center for Medicare and Medicaid Services has reversed a proposed policy to cut off paying for heart scans, which can cost $600 or more. The preliminary decision announced last December found no clinical evidence that heart scans identify heart disease any better than other non-invasive procedures, like a stress test. According to the paper:

Medicare’s initial proposal, which would have ended payment for the scans unless the patients were enrolled in studies to determine the technology’s effectiveness, had met with fierce resistance from the doctors who perform these scans and the companies that make the equipment. They strongly defended the use of these scans as an important alternative to traditional angiography.

Alternative to angiography? Patients who were previously sent directly to the cath lab (where the sneak a camera-led catheter through your leg into the blood vessels around the heart to look for blockages) will now get an expensive CT scan before being sent to the cath lab.

Meanwhile, patients who are borderline for catheterization will get the scans, and many of them will also be sent to the cath lab for the invasive procedure. Will the increased identification of these minor blockages and their stenting through catheterization save lives? No one knows. Will it send in many people for catheterization who really didn't need it? Absolutely, since there is always a some proportion of false positives with any imaging test. Yet:

“We found that the evidence is not black and white either way,” said Dr. Barry Straube, the chief medical officer for Medicare. Given the overwhelming criticism of the preliminary decision, the agency decided that it did not have enough reason to override the local carriers’ decision to cover the tests as medically necessary. “Before we make a significant change in policy, we need more evidence,” Dr. Straube said.

Lobbying by docs and equipment makers. Pay first, evidence later. It's the American way.