Sir William Osler, founding professor of Johns Hopkins Medical School. 

Physician Reimbursements

Plaque AI’s Reimbursement Milestone

The small list of cardiac imaging AI solutions to earn Medicare reimbursements just got bigger, following CMS’ move to add an OPPS code for AI-based coronary plaque assessments. That represents a major milestone for Cleerly, who filed for this code and leads the plaque AI segment, and it marks another sign of progress for the business of imaging AI.

With CMS’ October 1st OPPS update, Cleerly and other approved plaque AI solutions now qualify for $900 to $1,000 reimbursements when used with Medicare patients scanned in hospital outpatient settings. 

• That achievement sets the stage for plaque AI’s next major reimbursement hurdle: gaining coverage from local Medicare Administrative Contractors (MACs) and major commercial payers.

Cleerly and its qualifying plaque AI competitors join a slowly growing list of Medicare-reimbursed cardiac imaging AI solutions, headlined by HeartFlow’s FFRct ($930 – $950), which has now expanded across MAC regions and commercial payers. 

• The last 1.5 years also brought a temporary NTAP reimbursement for Caption Health’s echo AI guidance solution ($1,868) and a CPT III code for performing automated coronary artery calcium score assessments using chest CTs that were performed for other (non-CAC) reasons.

The new reimbursement should also drive advancements within the CCTA plaque AI segment, giving providers more incentive to adopt this technology, and providing emerging plaque AI vendors (e.g. Elucid, Artrya) a clearer path towards commercialization and VC funding.

The Takeaway

CMS’ new plaque AI OPPS code marks a major milestone for Cleerly’s commercial and clinical expansion, and a solid step for the plaque AI segment. 

The reimbursement also adds momentum for the overall imaging AI industry, which finally seems to be gaining support from CMS. That’s good news for AI vendors, since it’s pretty much proven that reimbursements drive AI adoption and are often necessary to show ROI.

ACC/AHA Chest Pain Guidelines Highlight FFRct

Coronary CTA + FFRct is now a front-line pathway in the ACC/AHA’s 2021 Chest Pain Guidelines, highlighting FFRct’s ability to guide physicians’ clinical diagnosis and revascularization decisions. Check out the clinical data supporting FFRct’s front-line positioning and how HeartFlowFFRct Analysis impacts patients, physicians, and administrators.

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The Wire

• Long-term P2Y12 Therapy After PCI: Three-year outcomes from the SMART-CHOICE trial showed that long-term P2Y12 inhibition after PCI reduced bleeding compared with dual antiplatelet therapy (DAPT), while keeping ischemic event rates stable. Three thousand patients took DAPT for three months post-PCI, and then either continued receiving DAPT or switched to P2Y12 monotherapy. At three years, the P2Y12 group experienced a 40% reduced bleeding risk, while the combined rate of stroke, heart attack, or all-cause death was comparable between the groups (6.1% vs. 6.3%). 

• Cardiologists’ Low EHR Satisfaction: A KLAS Arch Collaborative report revealed that cardiologists have among the lowest EHR satisfaction levels across physician specialties. The most satisfied physicians were in hospital medicine, pediatrics, and family medicine, although their scores only ranged from 30-39 points on a 100 point scale. Cardiology was near the bottom of the 26-specialty study (16.3pts, 5th lowest).

• Spironolactone for Alcohol Use Disorder: The heart failure and hypertension drug spironolactone may be a novel drug therapy for treating alcohol use disorder (AUD). Initially, the authors studied rodents and found that spironolactone reduced binge drinking in mice and reduced self-administration of alcohol in rats without any adverse effects. They also analyzed US Veterans data and found that spironolactone therapy was tied to reduced self-reported alcohol consumption, with the largest effects observed among those who reported hazardous/heavy alcohol use prior to starting spironolactone. 

• Interventional X-Ray & Mobile C-Arm Rebound: Signify Research reported strong 2021 rebounds in the interventional X-ray (+10.2%) and mobile C-arm (+15.5%) markets following COVID-related declines in 2020. The firm expects the two interventional segments will see continued (but slower) growth through 2026, with interventional X-ray demand driven by structural heart and neurology procedures, and mobile C-arm growth driven by the aging population and increasing awareness of the benefits of minimally invasive procedures. 

• Cre8 Evo Stent Loses Advantage: Alvimedica’s Cre8 EVO polymer-free drug-eluting stent did not maintain superiority over Medtronic’s Resolute Onyx permanent-polymer DES in an extended follow-up in patients with diabetes undergoing revascularization for coronary artery disease. At the 2021 TCT meeting the researchers reported that the Cre8 Evo was tied to a 35% risk reduction in target lesion failure (TLF), compared with Medtronic’s stent. But at this year’s meeting, both stents showed the same TLF rates (10.4% & 12.1%).

• Half of EHR Notes Are Copy+Paste: A new analysis of over 100M clinical notes found that an eye-popping 50.1% of the text was simply copied from previous notes on the same patient. The amount of duplication within notes also increased over time, from 33% in 2015 to 54.2% in 2020. The authors highlighted that duplication is a rational yet unsustainable response to “a documentation paradigm ill-suited to the task.”

• Understanding the INOCA Patient Experience: A survey of 300 patients diagnosed with INOCA – ischemia with no obstructive coronary arteries – highlighted just how damaging the oft-overlooked condition can be. Most respondents (78%) were told at some point that their symptoms weren’t cardiac. INOCA symptoms prompted 47% of respondents to retire early and 38% to apply for disability. Just 33% had cardiac catheterization with acetylcholine testing, despite invasive coronary function testing being recommended in the 2021 chest pain guidelines.

• Biome’s Cost & Quality Improvement Tool: Biome Analytics has released its Biome Performance Manager software, designed to help manage cardiovascular centers’ cost and quality improvement initiatives. Users input goals for discrete QI measures and can then instantly view the probable impact of any given intervention. Once an initiative is configured, Biome generates charts that allow hospital leaders to quantify and share positive impact in terms of patients benefited as well as cost and bed days saved.

• Genes Predict Blood Pressure: In a UK Biobank study of 331k participants, genetically predicted blood pressure was associated with cardiovascular disease risk, even after adjusting for measured blood pressure and antihypertensive medication prescription. Genetically predicted systolic BP was independently tied to an increased cardiovascular disease risk by 1.13-fold in normal blood pressure, 1.04-fold in untreated hypertension, and 1.06-fold in treated hypertension groups (median follow-up period: 11 years).

• FDA AI Final Guidance: Last week the FDA released several dense documents outlining how it will regulate different medical technologies. The most notable was the agency’s final guidance on what kinds of clinical decision support software and AI tools fall under its jurisdiction, in which the authors call out medical imaging systems and sepsis alert tools as requiring oversight. 

• Automated LDCT CAC Scoring: South Korean researchers demonstrated a commercially-available automated coronary artery calcium scoring solution’s ability to accurately produce CAC scores using low-dose CTs (LDCTs). The researchers performed automated CAC scoring on 567 ECG-gated CTs and LDCTs, finding that auto CAC scores from the gated CTs, LDCTs with 1mm slices, and LDCTs with 2.5mm slices closely matched manually-produced gated-CT CAC scores (ICCs: 1.000, 0.937, 0.955). The automated 1mm and 2.5mm LDCT CAC scores also accurately detected patients with ≥ 400 Agatston calcium scores (F1 scores: 0.929 & 0.855).

Stress Less with AI-Powered CCTA

Stress tests are today’s go-to method for detecting coronary artery disease, but should they be? Join experts from Cleerly and George Washington University on October 6th for a discussion exploring how we can improve CAD detection with AI-enabled CCTA.

User Experience and Cardiovascular Imaging Transformation

Check out this Change Healthcare video discussing the importance of user experience in the adoption of structured reporting, and how it can lead to improvements in imaging speed, quality, and cardiologist workflow.