Megan Tooley, Cardiovascular Roundtable
As previously discussed in Cardiovascular Rounds, a number of recent studies have evaluated the overall costs and downstream impact of coronary CT angiography (CCTA) in various patient populations.
Adding to this list is the ROMICAT II (Rule Out Myocardial Infarction Using Computer Assisted Tomography) trial. The study assessed if using CCTA as a first diagnostic test in the emergency department (ED) to rule out acute coronary syndrome (ACS) in low-to-intermediate risk patients is more effective than standard evaluation.
The trial results, published in the New England Journal of Medicine on July 26, further validate the utility of CCTA as a safe alternative to nuclear imaging for certain patients presenting to the ED with chest pain. While overall costs, including all subsequent downstream services, were modestly higher in the CCTA group on average, the efficiency gains from a CCTA-based diagnostic strategy are promising.
Overall, more patients were discharged from the ED with fewer admissions to an observation unit among those receiving CCTA compared to standard evaluation.
ROMICAT II: CCTA is safe and efficient in the ED, but not a cost cutter
Earlier this month, the National Quality Forum (NQF) endorsed four new measures aimed at tracking resource utilization within certain patient populations. The measures center on diabetes and cardiovascular care costs, requiring organizations to measure per member per month expenditures within each cohort. Maybe not surprisingly, CMS intends to add a similar measure to their VBP program aimed at isolating Medicare spending per beneficiary (MSPB).
These tandem efforts to redefine value of care may be indicators of what’s to come—increased scrutiny over total-cost-of-care management. As risk begins to shift towards providers with the advent of new payment models, organizations must learn to both understand and then inflect total cost of care in order to remain financially viable.
NQF endorses four new measures to redefine value of care