Budoff_foreword.qxp 5/8/08 11:04 Page 8
Foreword
Matthew J Budoff, MD
President, Society of Atherosclerosis Imaging and Prevention (SAIP)
Matthew J Budoff, MD, is an Associate Professor of Medicine at the David Geffen School of Medicine at the University of California, Los Angeles
(UCLA), and is Director of Cardiac Computed Tomography (CT) at Harbor-UCLA Medical Center in Torrance, California. Dr Budoff is President of
the Society of Atherosclerosis Imaging and Prevention (SAIP) and a founding Board Member of the Society of Cardiovascular CT. He served as
Chair of the American College of Cardiology (ACC)/American Heart Association (AHA) credentialing document for cardiac CT and magnetic
resonance. He has authored numerous articles that have appeared in peer-reviewed journals.
T
his year poses new challenges to cardiologists, with the subject of reimbursement becoming paramount. It is no secret
that cardiac imaging is a significant target for cost restriction. The attempts to restrict testing will include focusing on
appropriateness, competency, and board certification. However, these proposed restrictions may go beyond appropriate use.
Recently, cardiac computed tomography (CT) came under fire and was almost given ‘non-reimbursement’ status by Medicare.
This ‘near death’ experience for cardiac CT came about due to a lack of outcome studies.
There are plenty of outcome studies demonstrating that coronary calcium and plaque visualized on cardiac CT are associated
with worse prognosis. Medicare and Blue Cross/Blue Shield started asking: ‘Does visualization of plaque on CT lead to
improved patient outcomes?’ Thus, we are not asking only for a correct diagnosis from a diagnostic test, but also that it
ultimately leads to improved survival. This is problematic, as it would require patients to be randomized to standard of care
versus targeted therapy based on cardiac CT, and the estimates for sample size average about 40,000–50,000 participants. The
problem is not about validating cardiac CT, but the ramifications on our other, more commonly used tests in cardiology. We
have no data to suggest that stress treadmill testing improves outcomes, nor do we have data related to echocardiography,
nuclear cardiology, or even invasive angiography. If the payors, including Medicare, decide that the standard for imaging is not
to make a diagnosis, but to improve prognosis, we have an insurmountable problem in cardiology.
We are fortunate that we can base best practice in cardiology on clinical trials. For imaging, we will need to pool our data into
registries and demonstrate that those patients who undergo specific testing (with associated better diagnoses and more targeted
therapies) have better outcomes. We need to push for government funding to develop not only the adoption of electronic health
records that can communicate collectively, but also national registries to allow for follow-up of these patients. We must
collectively participate in these registries, for only those with a large participation will succeed.
This issue of US Cardiology contains information about new results regarding diagnostic tests and therapies for patients with
heart disease. It is now time that, as cardiologists, we continue to lead not only appropriate use and quality in health care, but
also demonstrate that by doing so outcomes are improved. I am confident that we can demonstrate that the tests we order will
lead to better diagnoses, which will translate into better outcomes.
We continue to assure payors that we can and will be appropriate in our use of imaging tests, and that through quality
improvements in outcomes are assured. It will cost for each of us to participate in clinical registries and national databases, but
it is now time to put our money where our mouths are. ■
8
© TOUCH BRIEFINGS 2008
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84