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Non-invasive testing, primarily nuclear multiplanar perfusion imaging (MPI), predicts abnormal findings on coronary angiography(CATH) in 41% of patients(Patel et al NEJM 362:886-95). Due to radiation doses associated with MPI studies, concern has risen about over-utilization. In September 2010 the largest private health insurance payor(and Medicare provider) in western Pennsylvania implemented a policy of 100% pre-authorization for MPI, purportedly to improve compliance with appropriate use criteria and reduce radiation exposure, placing time and cost demands on cardiology practices. This study asessed the effect of this payor policy on concordance of MPI and CATH.
Patients who had CATH in the 1st quarter of 2010 and underwent a MPI study within 4 weeks of CATH constituted the baseline patient cohort. Patients who had CATH in the 1st quarter of 2012 and underwent a MPI study within 4 weeks of CATH constituted the study patient cohort. Based on the final printed report, MPI studies were categorized as negative (no perfusion defects) or positive (at least 1 fixed or reversible defect). Based on the final printed report CATH studies were classified as positive (at least one lesion >70%) or negative (no lesion >70%). Concordance of MPI and CATH were computed for each time period and compared by independent samples t-test.
110 patients in the 1st quarter of 2010 had MPI and CATH, while 98 patients had both procedures in the 1st quarter of 2012. The MPI-CATH concordance was 50% for the 1st quarter of 2010 and 48% for the 1st quarter of 2012(p>0.05). 775 stress studies were performed 1st quarter 2010, 636 MPI(82.1%) and 139 non-MPI(17.9%). 906 stress studies were performed 1st quarter 2012, 676 MPI(74.6%) and 230 non-MPI(25.4%). The ratio of MPI procedures per quarter decreased (p<0.001) after policy implementation, while the ratio of non-MPI stress studies increased(p<0.001).
Payor policy did not improve concordance of MPI and CATH despite cost and time burdens on cardiology practices. There was a significant increase in non-MPI studies and decrease in MPI studies following policy implementation.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Improving Cardiovascular Health Services
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1201-110
- 2013 American College of Cardiology Foundation