Barry Meier reports in the New York Times on questions being put to cardiologists by Senators Grassley and Kohl regarding the propriety of financial ties between cardiologists and stent manufacturers. The article notes that the Cardiovascular Research Foundation (CRF) reported 2005 revenues of $47.2 million. Senators Grassley and Kohl are asking how much of those funds came from stent makers, including Abbott Laboratories, Medtronic, Boston Scientific, and Johnson & Johnson. In addition, the inquiry is focusing on 22 leading academic researchers.
Without taking anything away from the legitimate questions being raised about the need for transparency and disclosure in academic research, the questions skirt around a far more difficult issue: the relationship between physician compensation and physician decisionmaking.
Categories: Cardiology · FDA
Tagged: cardiologist, Cardiology, crf, grassley, kohl, physician compensation, stents
Alex Berenson and Reed Abselson report in the The New York Times on the increasing use of computed tomography (CT) angiograms in recent years. The use of CT angiogram, fueled by patient demand, is expected to rise substantially, despite questionable evidence of its benefit in most cases.
The article notes that CT angiogram can identify dangerous coronary plaque deposits that indicate a pressing need for surgery. In the future, CT angiograms may improve the treatment of heart disease if scanners can identify plaques that are likely to rupture. However, many cardiologists question the diagnostic value of routine use of the technology in light of the inability to determine which plaque-narrowed arteries actually pose a threat, coupled with the cost and cancer risk from radiation.
Medicare has considered restricting access to CT angiogram, but to date has not acted. In 2007, the Centers for Medicare and Medicaid Services (CMS) proposed requiring more studies before paying for CT angiograms but backed down in response to pressure from cardiologists who support CT angiograms.
Recommended Action: Although Medicare has deferred on this issue, in light of Medicare’s growing expressions of concern over future demand for and utilization of diagnostic imaging in general and CT angiogram in particular, restriction on reimbursement is likely in the future. Cardiologists, like all providers, need to stay abreast of Medicare reimbursement policy and to balance competing considerations (beyond patient demands) when recommending diagnostic imaging tests.
Harry Nelson is a partner in Fenton & Nelson, LLP. Fento & Nelson advises cardiologists and other providers on risk management and compliance matters. For additional information, please contact him at harry@fentonnelson.com
©Harry Nelson 2008
Categories: Cardiology · Medicare
