Utilization management of cardiovascular imaging pre-certification and appropriateness.
Rapid technological advances with enhanced clinical application have promoted the utility as well the growth of cardiac imaging. However, this has also raised concerns about over-utilization and inappropriate use in imaging. The imaging community, which initially took pride in increasing imaging volume, now fears limited access and reduced reimbursement. Nonclinicians, i.e., payers, have become gatekeepers to cardiac imaging, with decisions often lacking firm foundation within medical literature. The near-ubiquitous presence of radiology benefits managers is clearly impacting on the use of cardiac imaging, often through an indiscriminant reduction in imaging volume. Medical societies and clinicians were slow to respond to spiraling costs of cardiac imaging, but now recognize the need to promote appropriate and cost-conscious use of imaging. Through the development of guidelines and appropriateness criteria, physician-directed efforts are focused on eliminating unnecessary testing and promoting increased awareness of health care costs. This paper attempts to review some of the current issues concerning the responsible use of cardiovascular imaging.
Cardiology, Midwest Heart Specialists, Fox River Grove, Illinois, USA. rhendel@midwestheart.com
Robert C
RC
Hendel
D002309:Cardiology / Q000191:economics / Q000379:methods* / Q000592:standards; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000191:economics; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D003952:Diagnostic Imaging / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D004608:Eligibility Determination; D019983:Guideline Adherence; D017048:Health Care Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D019564:Unnecessary Procedures