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Recent Trends and Potential Drivers of Non-invasive Cardiovascular Imaging Use in the United States of America and England

Authors :
Timothy S E Albert
Victor A. Ferrari
Rocco Friebel
Huseyin Naci
Nay Aung
Yuchi Han
Steffen E. Petersen
Asmaa A M Kenawy
Source :
Frontiers in Cardiovascular Medicine, Vol 7 (2021), Frontiers in Cardiovascular Medicine
Publication Year :
2021
Publisher :
Frontiers Media S.A., 2021.

Abstract

Background: Non-invasive Cardiovascular imaging (NICI), including cardiovascular magnetic resonance (CMR) imaging provides important information to guide the management of patients with cardiovascular conditions. Current rates of NICI use and potential policy determinants in the United States of America (US) and England remain unexplored.Methods: We compared NICI activity in the US (Medicare fee-for-service, 2011–2015) and England (National Health Service, 2012–2016). We reviewed recommendations related to CMR from Clinical Practice Guidelines, Appropriate Use Criteria (AUC), and Choosing Wisely. We then categorized recommendations according to whether CMR was the only recommended NICI technique (substitutable indications). Reimbursement policies in both settings were systematically collated and reviewed using publicly available information.Results: The 2015 rate of NICI activity in the US was 3.1 times higher than in England (31,055 vs. 9,916 per 100,000 beneficiaries). The proportion of CMR of all NICI was small in both jurisdictions, but nuclear cardiac imaging was more frequent in the US in absolute and relative terms. American and European CPGs were similar, both in terms of number of recommendations and proportions of indications where CMR was not the only recommended NICI technique (substitutable indications). Reimbursement schemes for NICI activity differed for physicians and hospitals between the two settings.Conclusions: Fee-for-service physician compensation in the US for NICI may contribute to higher NICI activity compared to England where physicians are salaried. Reimbursement arrangements for the performance of the test may contribute to the higher proportion of nuclear cardiac imaging out of the total NICI activity. Differences in CPG recommendations appear not to explain the variation in NICI activity between the US and England.

Details

Language :
English
Volume :
7
Database :
OpenAIRE
Journal :
Frontiers in Cardiovascular Medicine
Accession number :
edsair.doi.dedup.....f81037a8fa83711b8cd5b3c3c4370ca4
Full Text :
https://doi.org/10.3389/fcvm.2020.617771/full