By Tanya Tolpegin, CAE

SCCT CEO

SCCT's first International Regional Committee, the Japan IRC, was founded in December 2008. SCCT's most recent International Regional Committee, the Canada IRC, was founded in December 2010. In this two year span, five other IRCs were also formed, with two more in current development state. Since 2010, we have also observed increases in membership by 42% in Latin America/Caribbean, by 49% in Japan, by 32% in the remainder of Asia, and by 43% in New Zealand. Our membership numbers reflect an undeniable fact: that growth in international activities and growth in international membership/participation is on the rise, and that can spell nothing but positive possibilities for the field of cardiac CT!

Commitment to a larger scale outreach of the CT community on a global scale is one of SCCT's primary goals going forward. SCCT's IRC groups are formed with the intention to promote cardiovascular CT and the objectives of SCCT in certain international regions, and provide new perspectives from emerging markets in order to make the cardiac CT community stronger as a whole. We would like to take the opportunity to reflect on some of the ongoing activities of the current active IRCs.

The 5th Annual Meeting of Japan Regional Committee was successfully held at Tokyo Conference Center Shinagawa, Tokyo on September 10, 2011, led by Sachio Kuribayashi, MD. The meeting had 247 attendees, nearly 20 new members joined SCCT, and there was good discussion throughout the conference. The program featured high quality talks and discussions, including two symposia, oral abstracts session, reports from SCCT Japan IRC board members and lectures by two guest speakers from SCCT, immediate past SCCT President Matthew J. Budoff, MD, FSCCT, and Suhny Abbara, MD, FSCCT.

In the first symposium, features of coronary plaques were presented from viewpoints of pathology and invasive diagnostic procedures, including IVUS and OCT. Cardiologists and radiologists then gave talks in terms of current status of coronary plaque diagnosis using cardiac CT. Strategies of how to use CT information in the management of patients with ischemic heart disease were discussed. In the second symposium, strategies of cardiac CT for further minimizing invasiveness were presented and discussed from viewpoints of radiation exposure, the amount of contrast medium, and contrast-induced nephropathy.

The Educational Committee of the Japan IRC reported on educational programs for skill increase in cardiac CT through e-learning, hands-on seminars, and lectures hosted on the web site. A guidelines committee was introduced and explained the recent SCCT published guidelines, including the Standard Medical Terminology guidelines document for cardiac CT and the Guidelines on Radiation Dose and Dose-Optimization Strategies. The committee is also currently in the process of translating the Standard Medical Terminology document into Japanese as an additional resource for its members. The next annual meeting of the IRC is scheduled to be held on September 8, 2012, in Tokyo.

Meanwhile, the newer IRCs have come out of the gate at full speed, and there is a promising array of upcoming events and meetings held throughout the coming months by SCCT's various IRCs.

The Canadian IRC held its first meeting on October 24 in Vancouver to discuss the future direction of the committee, and to plan for its 1st Annual Canadian SCCT CCTA Symposium in April.  Led by Canadian IRC President, Jonathon Leipsic, MD, FSCCT, this meeting was attended by 18 Cardiologists and Radiologists, including current SCCT President, James K. Min, MD, FSCCT.

The Europe IRC will host the CT Imaging for the Workup of TAVI Candidates and the 2nd European SCCT Meeting on December 16 in Munich, Germany. SCCT will be present at this meeting with a booth for information.The Europe IRC, as our second established IRC in the history of SCCT, will be highlighted at next year's 7th SCCT Annual Scientific Meeting, to be held July 19-22, 2012 in Baltimore, Maryland. Please continue to watch our website and announcements for specific details on this.

The Australia/New Zealand IRC reports that after considerable lobbying by the ANZCTCA Conjoint Committee for Training in CT Coronary Angiography, the Australian Federal Government announced the introduction of Reimbursement for CCTA as of July 1, 2011. The IRC also held a two-day CT meeting with Australia-NZ Endovascular Therapies (ANZET) and the CSANZ at the CSANZ meeting in Perth on August 11-13, 2011.

The Brazil IRC approved an official code for coronary CTA reimbursement at the Brazilian Health Agency on August 2, 2011. This code will enter in force after January 1, 2012.The First Annual Scientific Meeting of the Brazil IRC was also held on August 26-28 in Sao Paulo at the Paulista Plaza Hotel.

The Latin-America IRC is organizing a cardiac imaging course in March 2012 and will release information about this shortly. The Latin-America IRC is also currently collaborating with Brazil and other Latin America countries to write a book about cardiac CT and MR for the Latin America community.

SCCT looks forward to continuing yearly spotlighting of the various IRCs at the SCCT Annual Scientific Sessions held in July. For more information on the SCCT International Regional Committees and a full list of active chapters, please click here.  

As always, if you have any questions, the SCCT staff would be happy to help: please contact us at info@scct.org. Thank you for your membership, and your support of SCCT!

During the recent AMA Relative Value Update Committee (RUC) meeting, it was determined not to survey the cardiac CT services for presentation and revaluation in January 2012. Due to the volume of radiology/imaging services identified for review, there will be further discussion as to the process and priority for revaluation at that time.

Thank you for your willingness and commitment to participate in the survey process.  SCCT will keep you posted on the outcome of the January meeting and any opportunity to be involved.  As always, if you have any questions, please feel free to contact the SCCT office at 703-766-1706.

Payer Pulse 
In this edition of Payer Pulse, we highlight a new coverage policy for cardiac CT services announced by TrailBlazer Health Enterprises, LLC. This new policy may serve as a model for other Medicare contractors to follow.  

TrailBlazer Announces New Model LCD for Cardiac CT Services

Effective November 14, 2011, TrailBlazer Health Enterprises, LLC, the Part A and Part B Jurisdiction Medicare Administrative Contractor (MAC) for Colorado, New Mexico, Oklahoma and Texas, will implement a new local coverage determination (LCD) policy for cardiac CT services.  A dedicated team of SCCT volunteers worked to review, comment on and improve the draft policy over the last six months.

In general, the new coverage policy is based upon recommendations for appropriate clinical use, as outlined in the following published documents: 

• "2010 Expert Consensus Document on Coronary Computed Tomographic Angiography," published by the American College of Cardiology Foundation Task Force on Expert Consensus Documents, the American College of Radiology, American Heart Association, American Society of Nuclear Cardiology, North American Society for CardiovascularImaging, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, and Society of Cardiovascular Computed Tomography.
• "Appropriate Use Criteria for Cardiac Computed Tomography" published by The American College of Cardiology Foundation Appropriate Use Criteria Task Force, The Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.

The documents referenced above are available through the following hyperlinks:

http://content.onlinejacc.org/cgi/content/full/j.jacc.2009.11.013    

http://content.onlinejacc.org/cgi/content/full/j.jacc.2010.07.005 

The new policy generally provides coverage for cardiac CT and coronary computed tomography angiography for:

• Indications deemed "appropriate"  
• Indications deemed "uncertain" with an appropriateness rating of 6 or higher
• Upon medical review, the policy may cover those indications deemed "uncertain" with an appropriateness rating less than 6

Deficit Reduction Talks Could Mean More Imaging Policy Changes

Right now in Washington, the Joint Select Committee on Deficit Reduction is meeting to identify over $1 trillion in budget cuts to reduce the federal budget deficit. Medical imaging is once again a target.

Despite marked evidence of decreased growth in imaging services, some policymakers continue to believe that advanced diagnostic imaging services provided under Medicare should be subject to additional reimbursement cuts. Some lawmakers also back a proposal to require prior authorization of "high cost" imaging services provided to Medicare beneficiaries.

It is crucial that you continue to contact your lawmakers and urge them to reject all efforts to impose additional payment cuts or prior authorization for medical imaging services provided to Medicare beneficiaries. Call or write your U.S. Representative and your two U.S. Senators and convey the following points:

• Advanced diagnostic imaging services have sustained severe regulatory and legislative payment cuts over the last few years. These services continue to be subject to scrutiny despite the fact that imaging growth is slower than that of most other services under Medicare.
• The volume of advanced diagnostic imaging services provided to Medicare beneficiaries has slowed tremendously, and grew only 0.1 percent between 2008 and 2009.
• Reinforce the fact that medical imaging detects disease early, and therefore saves Medicare program dollars by avoiding delayed diagnoses and the onset of more advanced disease states.
• Make sure your lawmakers understand that prior authorization can serve as an impediment to patient care.
• Explain that experience with private payers suggests that a prior authorization requirement under Medicare would impose a significant burden on the program, increase practice costs, and lead to a delay in timely care or an ultimate denial of necessary services.
• Explain that the focus should be on the provision of appropriate care. Mention that SCCT worked very hard to develop appropriate use criteria for cardiac computed tomography. Also note SCCT's strong support for Congress' enactment of a Medicare demonstration project to test the use of appropriate use criteria and mandatory imaging laboratory accreditation in the Medicare Improvements for Patients and Providers Act.
• Most importantly, convey how continued cuts in medical imaging reimbursement will have a negative impact on patient access to needed imaging services in YOUR community.  Let them know what, if any alternatives there will be for your patients.

Be sure to ask your lawmakers to communicate their opposition to additional cuts and restrictions on imaging services to members of the Joint Select Committee on Deficit Reduction. Members of this Committee are:

Senators Max Baucus, John Kerry, Jon Kyl, Patty Murray, Rob Portman, and Patrick Toomey; Representatives Xavier Becerra, Dave Camp, James Clyburn, Jeb Hensarling, Fred Upton, and Chris Van Hollen.

If your lawmaker is a member of this Committee, ask him/her to work diligently to ensure that this Committee does not unfairly target patients and providers with additional imaging cuts.

If possible, meet with your lawmaker in their District or State office. The time spent on these meetings is very important. In the final analysis, lawmakers are more likely to respond to concerns raised from their constituents. This is why it is so important that you take the time to weigh in on this issue now. Members of the Joint Select Committee on Deficit Reduction must present their recommendations for deficit reduction by November 23, 2011. Please stand up NOW for patients and providers and help ensure the continued availability of advanced diagnostic imaging services.

MedPAC Recommends Repeal of Medicare's Sustainable Growth Rate Formula

In a recent letter to Congress, the Medicare Payment Advisory Commission (MedPAC) recommends a total repeal of the flawed Sustainable Growth Rate (SGR) formula that currently serves as the underpinning for Medicare physician payment. MedPAC is an independent body created by Congress to advise Congress on all Medicare policy matters.

MedPAC notes that the current Medicare physician payment system causes a lack of confidence in the Medicare program for patients and providers alike. MedPAC recommends a full repeal of the SGR despite the enormous cost associated with long term payment reform.   MedPAC proposes a series of legislated payment updates over ten years that would allow total Medicare fee-for-service expenditures to increase annually, with 2/3 of the increase attributable to growth in beneficiary enrollment, and 1/3 to growth in the use of services among beneficiaries.

MedPAC notes that the new payment scheme would reduce payment for most services, although less drastically than the substantive payment cuts slated to take effect under the SGR formula. MedPAC notes that access problems could become a real issue under the current Medicare physician payment formula, and that MedPAC's new policy recommendation could alleviate access problems and significantly greater reimbursement cuts.

Specifically, MedPAC recommends that primary care payments be frozen at current levels, while payment for all other services would be reduced by 5.9 percent for three years and then frozen for the subsequent seven years. MedPAC believes that primary care should be exempt from payment cuts due to the threat of increasing access problems in coming years.

SCCT will continue to monitor and weigh in as appropriate on all proposals to reform Medicare physician payment. We will be sure to update you when Congress debates specific payment reform proposals later this year.

 SCCT in the News 

SCCT President Appointed to the MEDCAC

SCCT President James K. Min, MD, FSCCT, was recently appointed by the Centers for Medicare and Medicaid Services (CMS) as a member of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC).

The MEDCAC acts as an advisory body to CMS in matters pertaining to health policy. Members appointed to the MEDCAC provide independent guidance and expert advice to CMS on specific clinical topics.   The MEDCAC reviews and evaluates medical literature, technology assessments, and examines data and information on the effectiveness and appropriateness of medical items and services that are covered under Medicare, or that may be eligible for coverage under Medicare. The MEDCAC judges the strength of the available evidence and makes recommendations to CMS based on that evidence.

CMS selects up to 100 experts in clinical and administrative medicine, biologic and physical sciences, public health administration, patient advocacy, health care data and information management and analysis, health care economics, and medical ethics to serve on the MEDCAC. We congratulate Dr. Min on this prestigious appointment.

Click here to read the full press release at the SCCT website.

CT-STAT Trial Finds CCTA Superior to MPI for Diagnosis of Early, Low-Risk Chest Pain in the Emergency Room

Vienna, VA (September 21, 2011) - The Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment (CT-STAT) trial, a multi-center trial published in the September 27, 2011 issue of the Journal of the American College of Cardiology suggests that employing early coronary computed tomographic angiography (CCTA) is faster and less costly than employing rest-stress myocardial perfusion imaging (MPI) in the evaluation of acute low-risk chest pain in the Emergency Department.

Click here to read the full press release at the SCCT website.

SCCT Technologist Webinar Series

SCCT is pleased to offer the SCCT Technologist Webinar Series. These one-hour webinars are designed to educate technicians on the how-to of cardiovascular CT.

December 8, 2011 - Low Dose Imaging for Cardiac CT  

Time: 12:00 p.m. - 1:00 p.m. EDT

Description: During this webinar you will learn how to reduce CCTA radiation dose including optimizing parameters and new technologies.

Faculty: James P. Earls, MD, FSCCT

CE Credit: This activity is approved for 1 credit by the ASRT

Registration: Click here

December 16, 2011 - CT Imaging for the Workup of TAVI Candidates 

Munich Airport; Hotel Kempinski

Munich, Germany

Registration: Click here 

July 18-19, 2012 - 5th Annual SCCT Comprehensive Board Review and Update of Cardiovascular CT 

The 5th Annual SCCT Comprehensive Board Review and Update of Cardiovascular CT will be a rigorous and comprehensive review of all aspects of cardiovascular CT principles, methodologies, and clinical practice.

July 19-22, 2012 - SCCT2012 

SCCT2012 covers completely new topics and is the only meeting devoted exclusively to cardiovascular CT.   This program will provide timely information on the technical principles, methods, clinical results, potential applications and limitations of cardiovascular CT and will update attendees with the most recent scientific data in the field.

SCCT Co-Sponsored Programs

January 20-22, 2012

Advances in Nuclear Cardiology and Cardiac CT: Case Review with the Experts

Cedars-Sinai, Los Angeles, California

For more information visit www.csmc.edu/cme 

May 3- 4, 2012 - Cardiac Imaging Australia (CIA)

Stamford, Brisbane

This one and a half day non-profit meeting is dedicated to quality, training and education in CCT and CMR. More information coming soon.  Please check the SCCT website, www.scct.org for updates.