Michigan Blues examine coronary CTA in pilot program

Blue Cross Blue Shield of Michigan and Blue Care Network are partnering with Michigan hospitals to examine whether coronary CT angiography, under certain circumstances, can be used as a complement or replacement for cardiac catheterization.

The open-ended study, scheduled to begin this month, will accumulate data regarding the technology's ability to contribute to patient health. At the same time, physicians at the participating hospitals will be looking for ways to improve the use of coronary CTA to make hospital resources more efficient. The data will lead to articles published in peer-reviewed journals, said Dr. Thomas Simmer, senior vice president and chief medical officer for the Blues in Michigan.

But the program is at least as much about the practical use of coronary CTA as it is about research.

Beginning July 1, hospitals and physicians participating in the study will be reimbursed for providing coronary CTA to members of the Blues' PPO and Point of Service, and the Blue Care Network. This breaks with the previous policy of Blue Cross Blue Shield of Michigan to not cover the test and could serve as an important first step toward mainstream adoption of this technology for patients complaining of chest pain.

Under the program, 21 Michigan hospitals have been certified to receive reimbursement and contribute data regarding the value of coronary CTA. They must use a 64-slice CT scanner, participate in the Michigan Blues' traditional and PPO hospital networks, and meet quality standards for both the procedure and staff training. Other providers could join by meeting these criteria, but widespread inclusion is not likely, Simmer said.

"We foresee an expansion of this program, as we learn more and as more organizations meet these criteria," Simmer told DI SCAN. "But if it turns out this technology is not as good as we had hoped, we don't want everybody to have bought expensive scanners and done training in a way that could not be justified to contribute to better care."

Eventually, data from this program could support a broad-based reimbursement policy for coronary CTA, he said, and could have an effect outside Michigan.

"Several other plans (outside the state) have already asked to examine what we are doing because they are interested in doing something similar," he said.

Interest in coronary CTA is part of a growing trend. Simmer noted that Medicare has begun reevaluating its payment policies for this technique.

Hospitals participating in the program will help determine the appropriate and best use of the test for the average heart patient compared with other available tests. The primary question will be whether coronary CTA offers faster and more definitive diagnoses.

"This could lead to improved care for cardiac patients and cost savings for the entire health system because a single coronary CTA scan could replace a series of standard cardiac tests," Simmer said.

Among tests that might be replaced are nuclear cardiology and cardiac cath, he said, once it is determined how well coronary CTA can assess the coronary arteries. This technology might also be used to rule out other causes of chest pain, such as aneurysms of the aorta or blood clots that travel to the lungs to form pulmonary emboli.

"This technology for imaging the heart has gotten so refined that it is now suggested that many patients presenting with chest pain should have this test performed rather than others," Simmer said. "Yet it is not clear that this test is better than alternative tests just as it is not clear whether there are other patients who should undergo this test."

Funding from Blue Cross Blue Shield of Michigan will help hospitals develop a database to evaluate coronary CTA, generate data that can lead to best-practice guidelines for hospitals, and start a continuous quality-improvement program in cardiovascular imaging. Each participating hospital will be able to compare its data with performance data accumulated from other hospitals in the study.