Top 5 Posts from the Digirad blog in 2018Posted on: 01.03.19
Digirad’s blog provides a variety of resources that keep you up to date on the ever-changing healthcare industry, including the advancements and issues that directly impact the operation of your practice. As we kick off a new year, here’s a look back at Digirad’s Top 5 Blog Posts from 2018:
Recent advancements in SPECT Myocardial Perfusion Imaging prompted ASNC to issue updated SPECT guidelines, which were published on May 25, 2018. The highly anticipated new guidelines, ASNC Imaging Guidelines: Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging—Instrumentation, Acquisition, Processing, and Interpretation, incorporate the most up-to-date information and advancements in SPECT technology since the previous 2010 ASNC SPECT guidelines were published. Continue Reading…
Cardiac PET has been used as a diagnostic imaging tool for a number of years, but has recently seen an increase in interest among cardiologists. When evaluating a considerable investment, such as Cardiac PET, it’s critical to look beyond the buzz and know for sure if it’s the right choice for your practice. Let’s take a look at Cardiac PET and some ways to see if it makes sense for you and your practice. Continue Reading…
We’re all familiar with the obstacles that radiotracers and subsequent gut activity presents during Myocardial Prefusion Imaging. When the radioisotope expands beyond the coronary arteries, it’s difficult to obtain quality SPECT MPI imaging of the heart. It’s a common problem that plagues many patients and physicians. So what do we do? Continue Reading…
The two most common approaches after identifying a solitary pulmonary nodule are the wait-and-see approach, or to move straight to a biopsy. While medically sound, both of these paths present risks for the patient that could be solved with a PET/CT scan. It’s a common misconception in nuclear medicine that a patient must have a cancer diagnosis before a PET/CT scan can be ordered. Continue Reading…
Myocardial Perfusion Imaging, also called a Nuclear Stress Test, is used to assess coronary artery disease, or CAD. CAD is the narrowing of arteries to the heart by the build up of fatty materials. CAD may prevent the heart muscle from receiving adequate blood supply during stress or periods of exercise. This frequently results in chest pain, which is called angina pectoris. Perfusion imaging usually consists of stress and rest tests. Continue Reading…
Medicare PET/CT Reimbursement for Oncology: What’s covered, what’s notPosted on: 08.16.18
PET/CT is a vital diagnostic imaging tool and is especially effective in revealing conditions such as cancer and brain disorders. When it comes to Medicare coverage, there are a number of misconceptions about PET/CT reimbursements.
In the majority of cases, PET/CT imaging is covered when clinically necessary, either as an initial treatment strategy or a subsequent treatment strategy.
Few exceptions apply to specific breast and cervical cancer, and melanoma diagnoses. The initial treatment of prostate cancer is the only non-covered event. Below is a consolidated reference chart that details PET/CT insurance reimbursement for specific conditions.
|Tumor Type||Initial Treatment Strategy||Subsequent Treatment Strategy|
|Breast Cancer (female & male)||*CWE||✓|
|Head & Neck Cancer (not thyroid or CNS)||✓||✓|
|Non-Small Cell Lung Cancer||✓||✓|
|Small Cell Lung Cancer||✓||✓|
|Soft Tissue Sarcoma||✓||✓|
|All other solid tumors||✓||✓|
|All other cancers not listed||✓||✓|
*CWE = Covered w/ exceptions
Cervical: Nationally non-covered for the diagnosis of cervical cancer related to initial anti-tumor treatment strategy. All other indications for initial anti-tumor treatment strategy for cervical cancer are nationally covered.
Breast: Nationally non-covered for initial diagnosis and/or initial staging of axillary lymph nodes. Nationally covered for initial staging of metastatic disease. All other indications for initial anti-tumor treatment strategy for breast cancer are nationally covered.
Melanoma: Non-covered for initial staging of regional lymph nodes. All other indications for initial anti-tumor treatment strategy for melanoma are nationally covered.
Leukemia: Nationally covered under “all other cancers not listed.”
Prostate cancer (dx 185.0) is not covered for initial treatment strategy. Therefore, all PI modifiers for 185.0 would be denied and PS modifiers would follow the same frequency as other cancer diagnosis codes.
Why you should rethink PET/CT imaging for prostate cancerPosted on: 06.28.18
The large majority of the nuclear imaging community would be quick to point out that PET/CT imaging with either 18Fluorodeoxyglucose (18FDG), or Sodium 18Fluoride (NaF18), is not effective in prostate cancer diagnosis. In fact, it’s not even approved for initial prostate treatment strategy.
With oncology imaging, most other cancers are green-lighted for both initial and subsequent treatment strategies. Prostate imaging, however, is only approved in the latter.
Radiopharmaceuticals and diagnosis
Because prostate cancer is a slow growing, less aggressive disease, the common sugar-based FDG is not an effective agent for diagnosis, but it can be used appropriately to identify metastasis in the body during subsequent treatment.
Sodium 18Fluoride (NaF18), has been used in bone imaging and was previously covered through the National Oncologic Pet Registry (NOPR). However, when the radiopharmaceutical reimbursement was discontinued in December 2017, it lost some of its popularity among physicians. Based on the NOPR study results, coverage is expected to be addressed in the future.
While prostate cancer is consistently one of the top three cancers in the nation, there are very few effective imaging solutions. Blood work, specifically through monitoring the prostate-specific antigen (PSA) level, delivers the majority of diagnoses. Any deviation from normal is an indicator, and may lead to surgery, cryotherapy, or radiation, as necessary.
One new radiopharmaceutical, two benefits
The relative newcomer to prostate cancer detection is Axumin (18F-Fluciclovine), which is indicated for PET imaging in men with suspected prostate cancer recurrence based on elevated PSA levels following prior treatment (chemical recurrence). By continuously monitoring PSA levels following treatment, Axumin can be used as soon as PSA levels begin trending upward leading to quicker detection.
Other imaging methods rely on physical changes in the body, whereas Axumin detects changes on the physiological level, which can develop weeks, even months earlier than physical changes. It ultimately presents a huge opportunity to fill the void in prostate imaging solutions.
An Axumin PET scan accurately identifies the cellular activity and location of a reoccurrence. While 18FDG is ideal for soft tissue, and NaF18 for bone imaging, Axumin offers the best of both worlds. Imaging studies show skeletal mass and metastasis throughout the body, including the prostate bed. When using Axumin, the imaging process begins right away and there is little to no bladder uptake visualized, whereas the traditional method of imaging with 18FDG typically has a great deal of bladder uptake. This bladder uptake, in some cases, obscures residual prostate cancer that may be in the prostate bed or regional lymph nodes.
The challenge with Axumin is its availability. It is currently available from only a handful of radiopharmacies throughout the U.S. and is only produced on certain days, with doses available during a short window of time. However, additional manufacturing sites are planned for 2018.
Smart ways to take advantage of the ASNC ImageGuide RegistryPosted on: 01.18.18
Launched in 2015, the ASNC ImageGuide Registry is the first national registry developed to support non-invasive cardiac imaging and reduce the increasing regulatory reporting burden. It effectively promotes and ensures continuous quality improvement for referring physicians, technologists, and laboratories by improving efficiency, elevating the level of patient care, and reducing downstream costs. With equal weight, it was designed with the desire to build a database that spurs new research that will, in turn, grow and expand the nuclear cardiology field.
Why is it important to physicians?
Across the entire healthcare insurance industry, plan payers are continuously moving toward value-based purchasing where cost and quality are major factors that help determine reimbursement levels. Alternative payment models, bundled payments, and higher deductible plans in the commercial insurance market and Medicare’s new quality payment and the MACRA MIPS programs are clear indications of the shift in direction. All lend themselves to physicians practicing within the clinical practice guidelines. The ImageGuide Registry can promote and reinforce the highest quality delivery of care and improve outcomes at an appropriate cost point, which, in turn, can help increase reimbursements.
In addition, the measures, which were created by and for ASNC members, are more meaningful to the nuclear cardiology industry than what would be reported through traditional MIPS measures, another way ASNC has committed to helping physicians achieve appropriate reimbursements and promoting the highest level of excellence in diagnostic imaging.
What are the benefits?
The ImageGuide registry allows physicians to submit data and, based on ASNC reporting guidelines, determine their level of performance. Are they testing the proper patients with the appropriate indications and using the applicable protocols? Are they using dose optimization strategies and returning reports to referring physicians on a timely basis? Physicians, or the practice administrator, can review the data over a given time period and identify areas for improvement.
Given the change in healthcare reform and the increase in out of pocket costs, patients are becoming more savvy. As consumers, they want to make sure they choose a physician that delivers the highest quality service, orders only the appropriate tests, and helps them avoid multiple copayments for unnecessary visits. The registry offers concrete evidence that helps physicians demonstrate the value they provide to patients who are paying more than they have in years passed.
Physicians will be able to use the registry to compare their performance against the 15 different metrics it tracks. And, because CMS has recognized ASNC’s ImageGuide Registry as a Qualified Clinical Data Registry (QCDR), physicians who participate and submit data to the registry will also meet the Physician Quality Reporting System (PQRS) requirements each year.
How do physicians submit data?
Data can be quickly and easily submitted manually through the register’s portal, which takes a speedy 60-90 seconds. If offices are using reporting software, like Sytermed, Cedars-Sinai, or INVIA, they’ll be able to automatically submit their data and bypass the manual entry.
ASNC asks that physicians submit their tests on a regular basis, without any cherry picking of cases. The objective is to review all tests to identify opportunities for improvement. Physicians will be able to view their individual data, but the practice administrator will be able to look a comprehensive report of the entire lab’s performance. Even though it’s physicians who are being tracked, it’s also helpful for the technologists because the registry tracks overall quality. It takes a whole team to improve the quality of service and care, so the reporting applies to the entire lab.
Who should join the ASNC Registry?
The registry is available to any nuclear cardiology lab or physician. In fact, for cardiologists who perform nuclear cardiology, participation in MIPS through ImageGuide is the most cost-efficient and effective method of submitting data. Because the benefit from Medicare applies to total Medicare receivables, and ImageGuide is specific to nuclear cardiology, physicians are able to track their imaging, improve it, and reap the benefits without having to submit as much data. Other registries often require the submission of all patient management.
Practices can be set up in the registry as a cardiac imaging group, a smaller practice, or simply as physicians performing nuclear cardiology. If you’re an ASNC member, the registry is complimentary with your paid membership. If you’re not a current member, the cost is $750 per year, which is still a prudent investment given the potential reduction in Medicare reimbursements it could help avoid.
An easy transition
If you think that participation in the registry will require heavy lifting, it’s quite the opposite. ASNC has support that can help will registration and data submission, initially and ongoing, so it’s not as difficult as one would think. If you’d like to get started, simply visit the ImageGuide portal and begin the enrollment process. If you have questions or need assistance, contact an ASNC representative.