Like Us and Follow Us on

January 20, 2012

ARDMS Updates and Headlines in the News:

ARDMS: Important Testing Center Update

Ultrasound Not Inferior for Sizing Renal Masses

Cardiologists Use of Noninvasive Imaging Fuels Medicare Growth

Ultrasound a Better Angle for Endometriosis Patients

ARDMS: Important Testing Center Update

• At the test center, you must present two current, valid signature IDs, one of which must be a non-expired government-issued photo ID with your signature; see the accepted list of IDs here.
• The name on your application must EXACTLY MATCH the name on both current, valid signature IDs.
• Jane R. Doe and Jane Rachel Doe DO NOT EXACTLY MATCH.
• Failure to present two acceptable IDs will prevent your admission to the test center. If this happens, you will be marked absent and you will forfeit the entire examination fee and seat.
• If the names do not EXACTLY MATCH, update your ARDMS name of record. 

Back To Top

Ultrasound Not Inferior for Sizing Renal Masses

Ultrasound imaging works as well as computed tomography (CT) and magnetic resonance imaging (MRI) for evaluating renal mass size, a new study suggests.

The finding “might be beneficial for long-term active surveillance protocols to contain healthcare costs and reduce radiation exposure,” researchers concluded.

Phillip Mucksavage, MD, of the University of California in Irvine, and colleagues studied 116 patients who underwent ultrasound imaging prior to definitive therapy for a renal mass. These patients also underwent CT (66 patients) or MRI (80 patients). Thirty-three patients underwent all three imaging modalities. The average pathologic tumor size for the entire cohort was 4.45 cm.

The renal mass size differences between CT and MRI compared with ultrasound were nonsignificant (less than 3.5%), Dr. Mucksavage's team reported in Urology. For patients who underwent ultrasound and CT, the average tumor size was 4.73 cm and 4.57 cm, respectively. For those who underwent ultrasound and MRI, the average tumor size was 4.65 cm and 4.49 cm, respectively. For patients who underwent ultrasound, CT, and MRI, the average tumor size was 4.47 cm, 4.27 cm, and 4.29 cm, respectively.

In an accompanying editorial, Maxwell V. Meng, MD, of the University of California, San Francisco, School of Medicine, observed: "Although the urologist is traditionally most comfortable interpreting cross-sectional images, particular CT, we must question the established paradigms and evolve to incorporate comparable modalities with less morbidity for the patient and reduced for cost for healthcare system."

View the article online.

Article written by staff at renalandurologynews.com and adapted for the purposes of this newsletter.

Back To Top

Cardiologist Use of Noninvasive Imaging Fuels Medicare Growth

The services and allowed charges by cardiologists for treating Medicare patients increased dramatically between 1999 and 2008, according to an analysis published online in Circulation: Cardiovascular Quality and Outcomes. Much of the growth was linked to noninvasive imaging, with resting echocardiograms and nuclear stress testing fueling the lion’s share of growth.

Bruce W. Andrus, MD, and H. Gilbert Welch, MD, MPH, both of the Dartmouth Institute for Health Care Policy and Clinical Practice at Dartmouth Medical School in Hanover, N.H., used fee-for-service Medicare Part B claims from 1999 to 2008 for their analysis. They grouped the roughly 1,000 CPT-9 codes submitted by cardiologists into 45 service categories and then assigned them to one of three types: evaluation and management, noninvasive procedures and invasive procedures.

They calculated utilization rates for each of the 45 categories and determined changes in volume using 1999 as a base year. Their primary outcome measures were services and allowed charges per 1,000 beneficiaries.

They found that cardiologists’ claims increased 44 percent between 1999 and 2008, and allowed charges rose 28 percent after adjusting for inflation. Noninvasive procedures gobbled up most of the growth, accounting for 78 percent of the total increase in services. Invasive procedures accounted for a modest 5 percent and evaluation and management totaled 17 percent.

When Andrus and Welch examined components within noninvasive procedures, they traced much of the rise to echocardiography and nuclear stress testing. They found that the rate of transthoracic echocardiography had nearly doubled while stress tests with nuclear imaging had tripled over the decade. Echocardiography and nuclear stress testing took up 32 percent and 16 percent, respectively, of total growth in services and 18 percent and 27 percent, respectively, of the total growth in charges.

“Increasing utilization of nuclear stress testing and echocardiography strains the sustainability of Medicare and drives declining reimbursement for these studies,” they wrote. “Increasing expenditures, more broadly, hinder efforts to maintain current benefits, consider new services or expand access to healthcare.”

They speculated on reasons for the uptick in noninvasive imaging: patient preference, lack of confidence in physical examinations, new indications for defibrillators and cardiac resynchronization therapy, a desire to monitor patients more closely, efforts to avoid litigation and more mid-level practitioners involved in care. They also added that utilization may be tied to efforts to compensate for losses from declining revenue in other areas of a cardiology practice.

Study limitations included the fact that within the 10-year period under study, designations in Medicare trended away from multi-specialties, which could have led to some misattributions in the study. The data did not include charges for the technical component of services, which may have led to underestimation of the growth in spending, they wrote.

Andrus and Welch praised the use of appropriate use criteria and integration of evidence-based recommendations into EMR systems. They highlighted the approach as preferable to across-the-board cuts in reimbursements. “[W]e are concerned that increased expenditures on imaging puts undesirable downward pressure on reimbursement for bedside evaluation and management services—a careful history and examination, explaining the assessment and reviewing options—services that we believe are underrepresented,” they concluded.

View the article online.

Article written by staff at cardiovascularbusiness.com and adapted for the purposes of this newsletter.

Back To Top

Ultrasound a Better Angle for Endometriosis Patients

An ultrasound is just as effective as an invasive surgical procedure in diagnosing the female reproductive disorder endometriosis, a Melbourne specialist has found, in a development that could lead to more women being treated for the painful condition.

Dr. Sofie Piessens found the new technique was more than ninety percent effective at diagnosing endometriosis, in an analysis of 100 patients she saw between 2009 and last year.

She presented her findings at the annual scientific meeting of the Royal Australian and New Zealand College of Obstetricians and Gynecologists.

About 15 percent of women have endometriosis, which can cause severe pain and damage reproductive organs, leading to infertility in up to 50 percent of cases.

Dr. Piessens said the disorder,  in which the cells lining the uterus migrate to the abdomen , was usually diagnosed with a laparoscopy, an operation to inspect the pelvic organs.

''Some people will have painful periods but not endometriosis, so to do a laparoscopy on everyone who has painful periods was quite invasive,'' she said.

''A lot of women are told the pain is normal and they have to put up with it, so there can be a significant delay in diagnosis and the endometriosis can become quite severe.''

Dr. Piessens, a gynecologist who specializes in ultrasound, said doctors had previously believed that ultrasounds could not detect endometriosis. “Now groups around the world have published data to say if you just look backwards, behind the uterus, you can diagnose a high proportion of women who have that really bad form of endometriosis,'' she said.

''With a normal vaginal ultrasound we look right ahead at the uterus, we turn it to the side to look at the ovaries, and I would like people to just look behind the uterus as well to look for endometriosis.

''It's something people need to become aware of and my feeling is, if there is demand from referring doctors, then imaging people will lift their game and look harder.''

Dr. Piessens said the result was a speedier diagnosis which provided a template for surgeons performing complex surgery to remove the lesions.

She said the ultrasound could also be used to monitor the effect of hormone medication in shrinking the lesions, potentially avoiding surgery.

One of the patients who has benefited from the new diagnostic technique is Alana Vaughan, 29, who suffered for years with painful periods.

She said her symptoms ''Returned with a vengeance'' when she stopped taking the contraceptive pill a few years ago, before she was referred to Dr. Piessens who diagnosed her endometriosis. After extensive surgery to remove it, Ms. Vaughan said she had experienced a ''Fantastic reduction in symptoms'' and was now thrilled to be pregnant with twins.

View the article online.

Article written by staff at theage.com.au and adapted for the purposes of this newsletter.

Back To Top