Medicare rule change encourages premium CT use

Rule changes slated for adoption by Medicare could be a factor when choosing the type of CT scanner to buy. The changes are part of an effort to diagnose patients earlier.

Today, hospitals have until a patient is released to make a diagnosis, which serves as the basis for determining Medicare payment. When the government adopts the proposed Medicare Severity DRG (diagnostic-related groups) classification system, however, hospitals will have only 24 hours.

That's good news for the vendors of premium CT scanners, according to Doug Ryan, senior director of Toshiba's CT business unit.

"Hospitals are going to be looking for technology that allows them to make the diagnosis at a lower cost, because every piece of equipment used in that period applies to the fixed reimbursement amount," Ryan said. "If a CT can eliminate two or three devices being used in the testing, this would be huge for the hospital CEO."

The new rule change, set to take effect Oct. 1, will place a premium on quick decision making. This could directly affect how CT is applied in the hospital, particularly as it applies to blunt trauma patients.

Emergency departments were among the first to adopt multislice CTs. Quick scans of the body have been used to check for aortic injury, for example, following car accidents. These scans sometimes are indeterminate, however, leading physicians to schedule catheter angiography.

But research published in the October issue of Radiology indicates that of 72 patients whose CTAs were inconclusive, no aortic injuries were missed on the CT-based evaluation.

"If CT angiography is used alone, the patient can be spared an invasive catheter angiogram, risks of which include vascular injury, hemorrhage, infection, and even death," said lead author Dr. Marla Sammer, a radiology resident at the University of Washington in Seattle. "Furthermore, since patients with suspected aortic injury often have multiple other life-threatening injuries, the time spent performing the catheter angiogram can be used instead to more rapidly diagnose and treat other injuries."

Premium scanners offer the greatest advantage in the emergency department, because of detail found in thin-slice studies. This advantage will be amplified when the diagnostic process is shortened by the new Medicare rules, according to Ryan.

Data on 64-slice high-resolution scans can be examined in greater detail after the initial patient assessment, when physicians begin to home in on the final diagnosis. Rather than doing 16 slices at 1 mm or 2 mm, the 64-slice scanner can capture a data set of submillimeter slices.

"The speed of the scan is identical because the 16 by 2 takes the same time as a 64 by 0.5 (on the Aquilion 64)," Ryan said. "The difference is in the detail of the data and the ability to do reformations in sagittal, coronal, and oblique planes."