Evolving trends in the use of echocardiography: a study of Medicare beneficiaries.

OBJECTIVES: We studied the use of echocardiography among Medicare beneficiaries between 1999 and 2004 to determine the rate of growth in these services and evaluate the drivers of growth. BACKGROUND: Concerned about increasing health care costs, federal and private payers have highlighted growth in diagnostic imaging studies and begun to develop approaches to curb this growth. METHODS: Medicare Part B Physician/Supplier Procedure Summary Master File and enrollment data from 1999 to 2004 were reviewed. Total Medicare carrier-paid spending for echocardiography services was determined from procedure volumes and allowed charges. The 5% standard analytic file of physician claims was used to evaluate geographic variations in use and to document the specialties of physicians who request and those who interpret echocardiograms. RESULTS: Between 1999 and 2004, echocardiography services grew at a rate similar to that for all medical services subject to Medicare's sustainable growth rate (SGR) calculation. Increasing provision of echocardiograms in physicians' offices contributed to increased spending under the SGR. Accounting for this shift, actual annualized per capita growth in echocardiography was 7.7%. Variations in the prevalence of heart disease contributed to geographic variations in use. Although cardiologists were the most common providers of echocardiographic services, primary care physicians ordered the majority of these diagnostic procedures. CONCLUSIONS: Growth in the use of echocardiography is in keeping with the general growth in medical services. Nonetheless, physicians who order echocardiograms and those who provide them must work together to ensure that in the future these diagnostic services are used appropriately and not excessively.

Implementing contrast echocardiography in the laboratory.

Contrast echocardiography is an important and a significant addition to a modern echocardiography laboratory. Its successful implementation is dependent on a team approach between sonographers, nurses, and physicians. A practical plan is one that includes a proper understanding of indications, logistical matters, technical and performance standards, and reimbursement issues.

Reimbursement for new diagnostic imaging technologies: process, progress, and problems.

The use of a new diagnostic procedure involves many challenges, including securing reimbursement for its use. Although this may seem a mundane concern, technologies that are not reimbursed are often not used and, certainly, are not used widely.

The role of contrast enhancement in echocardiographic assessment of left ventricular function.

With or without contrast, echocardiographic evaluation of left ventricular (LV) function is qualitative, subjective, and experience dependent, because it is mostly based on visual interpretation of gray-scale 2-dimensional images or, at best, relies on tedious and time-consuming manual tracing of the endocardial boundaries. Adequate endocardial visualization is essential for accurate interpretation of regional wall thickening abnormalities, which constitute the diagnostic hallmark of coronary artery disease, and for reproducible assessment of LV ejection fraction. Studies performed in the last decade have estimated the number of patients with suboptimal endocardial delineation by fundamental imaging at 30%. These studies have highlighted the problem of variable image quality as a major limitation of transthoracic echocardiography because failure to adequately visualize a segment, either at rest or during stress, may compromise the ability of this technique to identify areas of dysfunctional myocardium. Several remedies based on different technologic and methodologic approaches have been tested over the years with variable success. In this review we discuss the most recent techniques that have had a positive impact on endocardial visualization, as well as the potential benefits of these approaches.