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Dranove D, Garthwaite C, Heard C, Wu B. The economics of medical procedure innovation. JOURNAL OF HEALTH ECONOMICS 2022; 81:102549. [PMID: 34979301 DOI: 10.1016/j.jhealeco.2021.102549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 06/14/2023]
Abstract
This paper explores the economic incentives for medical procedure innovation. Using a proprietary dataset on billing code applications for emerging medical procedures, we highlight two mechanisms that could hinder innovation. First, the administrative hurdle of securing permanent, reimbursable billing codes substantially delays innovation diffusion. We find that Medicare utilization of innovative procedures increases nearly nine-fold after the billing codes are promoted to permanent (reimbursable) from provisional (non-reimbursable). However, only 29 percent of the provisional codes are promoted within the five-year probation period. Second, medical procedures lack intellectual property rights, especially those without patented devices. When appropriability is limited, specialty medical societies lead the applications for billing codes. We indicate that the ad hoc process for securing billing codes for procedure innovations creates uncertainty about both the development process and the allocation and enforceability of property rights. This stands in stark contrast to the more deliberate regulatory oversight for pharmaceutical innovations.
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Affiliation(s)
- David Dranove
- Kellogg School of Management, Northwestern University, 2211 Campus Drive, Evanston, IL 60208, USA.
| | - Craig Garthwaite
- Kellogg School of Management, Northwestern University, 2211 Campus Drive, Evanston, IL 60208, USA.
| | - Christopher Heard
- Department of Economics, Northwestern University, 2211 Campus Drive, Evanston, IL 60208, USA.
| | - Bingxiao Wu
- Department of Economics, Rutgers University, 75 Hamilton St, New Brunswick, NJ 08901, USA.
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Popic J, Tipuric S, Balen I, Mrzljak A. Computed tomography colonography and radiation risk: How low can we go? World J Gastrointest Endosc 2021; 13:72-81. [PMID: 33763187 PMCID: PMC7958467 DOI: 10.4253/wjge.v13.i3.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/23/2021] [Accepted: 02/19/2021] [Indexed: 02/06/2023] Open
Abstract
Computed tomography colonography (CTC) has become a key examination in detecting colonic polyps and colorectal carcinoma (CRC). It is particularly useful after incomplete optical colonoscopy (OC) for patients with sedation risks and patients anxious about the risks or potential discomfort associated with OC. CTC's main advantages compared with OC are its non-invasive nature, better patient compliance, and the ability to assess the extracolonic disease. Despite these advantages, ionizing radiation remains the most significant burden of CTC. This opinion review comprehensively addresses the radiation risk of CTC, incorporating imaging technology refinements such as automatic tube current modulation, filtered back projections, lowering the tube voltage, and iterative reconstructions as tools for optimizing low and ultra-low dose protocols of CTC. Future perspectives arise from integrating artificial intelligence in computed tomography machines for the screening of CRC.
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Affiliation(s)
- Jelena Popic
- Department of Radiology, University Hospital Merkur, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Sandra Tipuric
- Department of Family Medicine, Health Center Zagreb-East, Zagreb 10000, Croatia
| | - Ivan Balen
- Department of Gastroenterology and Endocrinology, General Hospital Slavonski brod “Dr. Josip Bencevic”, Slavonski Brod 35000, Croatia
| | - Anna Mrzljak
- Department of Medicine, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
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Moreno CC, Yee J, Dachman AH, Duszak R, Goldman L, Horný M. Use of Screening CT Colonography by Age and Race: A Study of Potential Access Barriers Related to Medicare Noncoverage Based on Data From the ACR's National CT Colonography Registry. J Am Coll Radiol 2020; 18:19-26. [PMID: 33086049 DOI: 10.1016/j.jacr.2020.09.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The primary objectives of this investigation were to evaluate the use of screening CT colonography (CTC) examinations by age comparing individuals of Medicare-eligible age to younger cohorts and to determine if the association between use of CTC and Medicare-eligible age varies by race. Although the Affordable Care Act requires commercial insurance coverage of screening CTC, Medicare does not cover screening CTC. MATERIALS AND METHODS Using the ACR's CTC registry, the distribution of procedures by age was evaluated using a negative binomial model with patient age (to capture overall trend), indicator of Medicare-eligible age (to capture immediate changes in trend at age 65), and their interaction (to capture gradual changes after age 65) as independent variables. The association between the number of screening CTCs and age was compared by racial identity. RESULTS The CTC registry contained data on 12,648 screening examinations. Between ages 52 and 64, the number of screening examinations increased; each additional age year was associated with a 5.3% (P < .001) increase in the number of screenings. However, after age 65, the number of screening examinations decreased by -6.9% per additional year of age above 65 compared with the trend between ages 52 and 64 (P < .001). The modal age group for CTC use was 65 to 69 years in white and 55 to 59 in black individuals. CONCLUSION After age 65, the number of screening CTC examinations decreased, likely due, at least in part, to lack of Medicare coverage. Medicare noncoverage may have a disproportionate impact on black patients and other racial minorities.
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Affiliation(s)
- Courtney C Moreno
- Chair, ACR CT Colonography Registry Committee; member, ACR National Radiology Data Registry Steering Committee; member, ACR Colon Cancer Committee; Emory University School of Medicine, Atlanta, Georgia.
| | - Judy Yee
- Chair, ACR Colon Cancer Committee; Montefiore Health System and Chair of Radiology at Albert Einstein College of Medicine, Bronx, New York
| | - Abraham H Dachman
- Member, ACR CT Colonography Registry Committee; member, ACR National Radiology Data Registry Steering Committee; member, ACR Colon Cancer Committee; The University of Chicago, Chicago, Illinois
| | - Richard Duszak
- Professor and Vice Chair, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | | | - Michal Horný
- Assistant Professor, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Assistant Professor, Emory University Rollins School of Public Health, Atlanta, Georgia
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Geographic Dispersion and Rural Versus Urban Utilization of CT Colonography in the United States. J Am Coll Radiol 2020; 17:475-483. [DOI: 10.1016/j.jacr.2019.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 02/06/2023]
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French RJ, Rosman DA, Tailor TD, Hemingway J, Hughes DR, Duszak R, Rosenkrantz AB. Changes in Current Procedural Terminology Coding and Its Effect on Specialty-Level Utilization of Musculoskeletal Ultrasound. Curr Probl Diagn Radiol 2020; 50:337-343. [PMID: 32220538 DOI: 10.1067/j.cpradiol.2020.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/12/2020] [Accepted: 02/25/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Concerns regarding increasing utilization of non-vascular extremity ultrasound (US) imaging led to the Current Procedural Terminology (CPT) Editorial Panel separating a singular billing code into distinct comprehensive and focused examination codes with differential reimbursement. We explore this policy change's temporal association with utilization. METHODS Using Physician/Supplier Procedure Summary Master Files, we identified all nonvascular extremity US services billed for Medicare fee-for-service beneficiaries between 1994 and 2017. These included generic (CPT code 76880 from 1994 to 2010), complete (code 76881 from 2011 to 2017), and limited (code 76882 from 2011 to 2017) examinations. Annual utilization per 100,000 beneficiaries was computed and stratified by billing specialty. Compound annual growth rates were calculated. RESULTS Radiologists and podiatrists were the top 2 billing specialties for nonvascular extremity US examinations. From 1994 to 2010, radiologist services increased 6.1% annually. Following the 2011 code separation, radiologists' utilization increased 2.7% annually for complete and 12.3% for limited exams. Between 1994 and 2017, radiologists' market share decreased 72.8% to 40.4%. From 1994 to 2010, podiatrist services increased 87.1% annually. Following the code separation, podiatrists' annual utilization growth stabilized 0.4% for complete and 0.6% for limited exams. Podiatrists' market share was 9.1% in 2001, peaked at 31.3% in 2009, and declined to 14.3% in 2017. CONCLUSIONS Prior rapid growth in extremity nonvascular US for podiatrists slowed considerably following CPT code separation in 2011. Subsequent service growth has largely been related to less costly, focused examinations performed by radiologists. Further study may help better understand how CPT coding changes alter imaging utilization more broadly.
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Affiliation(s)
| | - David A Rosman
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Tina D Tailor
- Department of Radiology, Duke Health System, Durham, NC
| | | | - Danny R Hughes
- Harvey L. Neiman Health Policy Institute, Reston, VA; School of Economics, Georgia Institute of Technology, Atlanta, GA
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
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Volume and Coverage of Secondary Imaging Interpretation Under Medicare, 2003 to 2016. J Am Coll Radiol 2018; 15:1394-1400. [DOI: 10.1016/j.jacr.2018.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/13/2018] [Indexed: 11/22/2022]
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Translating New Imaging Technologies to Clinical Practice. Acad Radiol 2018; 25:3-8. [PMID: 28843464 DOI: 10.1016/j.acra.2017.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 03/30/2017] [Indexed: 11/24/2022]
Abstract
Radiology continues to benefit from constant innovation and technological advances. However, for promising new imaging technologies to reach widespread clinical practice, several milestones must be met. These include regulatory approval, early clinical evaluation, payer reimbursement, and broader marketplace adoption. Successful implementation of new imaging tests into clinical practice requires active stakeholder engagement and a focus on demonstrating clinical value during each phase of translation.
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Ultrasound Elastography With Imaging: Overcoming Emerging Technology Reimbursement Challenges. J Am Coll Radiol 2017. [DOI: 10.1016/j.jacr.2017.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Changing Musculoskeletal Extremity Imaging Utilization From 1994 Through 2013: A Medicare Beneficiary Perspective. AJR Am J Roentgenol 2017; 209:1103-1109. [DOI: 10.2214/ajr.17.18346] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
PURPOSE Prior work has demonstrated marked growth in the volume of abdominal imaging performed by radiologists. However, decisions to pursue imaging are largely driven by referring providers. In this study, we take the novel approach of investigating abdominal imaging utilization patterns by referring provider specialty. METHODS Data on imaging services were obtained from the 2014 DocGraph Medicare Referring Provider Utilization for Procedures (MrPUP) public use file. MrPUP contains aggregated transaction data for combinations of unique referring provider and service code. Imaging services were classified by modality and body region using the Neiman Institute Types of Service (NITOS). Each referring provider's specialty was determined using Medicare Physician Compare. Abdominal imaging ordering patterns were summarized by referring specialty. RESULTS The final dataset included 5,824,754 abdominal imaging transactions. The most common ordering specialties of abdominal imaging were as follows: (1) internal medicine; (2) urology; (3) emergency medicine; (4) family practice; and (5) gastroenterology. The most common ordering specialties by abdominal imaging modality were emergency medicine for CT; gastroenterology for MRI and nuclear medicine; and internal medicine for ultrasound and radiography. While numerous specialties commonly ordered abdominal radiography and CT, urologists also commonly ordered retroperitoneal ultrasound and retrograde urography, and gastroenterologists also commonly ordered abdominal ultrasound, abdominal MRI, and esophagrams. Internal medicine, family practice, and emergency medicine providers ordered a much broader mix of imaging, including many non-abdominal imaging examinations. CONCLUSION Referring specialty abdominal imaging ordering patterns are varied but distinct. Awareness of these patterns may facilitate focused educational and policy initiatives to improve abdominal imaging appropriateness and utilization.
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Lu MT, Hallett TR, Hemingway J, Hughes DR, Hoffmann U, Duszak R. Secondary Interpretation of CT Examinations: Frequency and Payment in the Medicare Fee-for-Service Population. J Am Coll Radiol 2016; 13:1096-101. [DOI: 10.1016/j.jacr.2016.01.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
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Reassessing medicare trends in diagnostic CT colonography after achieving CPT code category I status. Abdom Radiol (NY) 2016; 41:1357-62. [PMID: 26880175 DOI: 10.1007/s00261-016-0636-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Compare national trends in utilization and coverage of diagnostic (non-screening) computed tomography colonography (CTC) in the Medicare population before and after achieving Current Procedural Terminology(®) (CPT) Category I code status in 2010. METHODS Claims by provider type and location for diagnostic CTC were identified between 2005 and 2013 using Medicare Physician Supplier Procedure Summary Master Files. Frequencies of billed and denied services were used to calculate denial rates for CTC and abdominal computed tomography (CT). PubMed search for articles with "CT colonography" in abstract or title during 1997-2013 was performed. Publications were recorded yearly and matched to CTC denial rates. RESULTS Annual Medicare claims for diagnostic CTC increased 212% during 2005-2009 in Category III status and increased 27.4% during 2009-2013 after implementation of Category I codes. Claims for abdominal CT rose 13.4% over the same overall period. Denial rates decreased from 70% to 32.8% between 2005 and 2009, and fluctuated between 24.7 and 30.6% thereafter. Denial rates for abdominal CT remained constant (4.1%-4.6%). From 2005 to 2013, services grew most in the private office (1678-7293) and hospital outpatient (1644-6449) settings with radiologists performing 93.3% of CTC. 1037 CTC publications were identified which increased 3567% between 1997 (3) and 2008 (107), plateaued until 2010 (114) and declined thereafter (75 in 2013). CONCLUSIONS Diagnostic CTC grew dramatically from 2005 to 2009, but slowed thereafter; even after achieving CPT Category I code status in 2010. Medicare denial rates declined during early years but later stabilized which paralleled a slowing in new peer-reviewed research. CTC continues to be performed predominately by radiologists in the outpatient setting.
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Moreno CC, Hemingway J, Johnson AC, Hughes DR, Mittal PK, Duszak R. Changing Abdominal Imaging Utilization Patterns: Perspectives From Medicare Beneficiaries Over Two Decades. J Am Coll Radiol 2016; 13:894-903. [PMID: 27084072 DOI: 10.1016/j.jacr.2016.02.031] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE To assess changing utilization patterns of abdominal imaging in the Medicare fee-for-service population over the past two decades. METHODS Medicare Physician Supplier Procedure Summary master files from 1994 through 2012 were used to study changes in the frequency and utilization rates (per 1,000 Medicare beneficiaries per year) of abdominal CT, MRI, ultrasound, and radiography. RESULTS In Medicare beneficiaries, the most frequently performed abdominal imaging modality changed from radiography in 1994 (207.4 per 1,000 beneficiaries) to CT in 2012 (169.0 per 1,000). Utilization rates of abdominal MR (1037.5%), CT (197.0%), and ultrasound (38.0%) all increased from 1994-2012 (but declined briefly from 2007 to 2009). A dramatic 20-year utilization rate decline occurred for gastrointestinal fluoroscopic examinations (-91.9% barium enema, -80.0% upper gastrointestinal series) and urologic radiographic examinations (-95.3%). Radiologists were the dominant providers of all modalities, accounting for >90% of CT and MR studies, and >75% of most ultrasound examination types. CONCLUSIONS Medicare utilization of abdominal imaging has markedly changed over the past two decades, with overall dramatic increases in CT and MRI and dramatic decreases in gastrointestinal fluoroscopic and urologic radiographic imaging. Despite these changes, radiologists remain the dominant providers in all abdominal imaging modalities.
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Affiliation(s)
- Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
| | | | - Aileen C Johnson
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Danny R Hughes
- Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - Pardeep K Mittal
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Harvey L. Neiman Health Policy Institute, Reston, Virginia
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Theis J, Kim DH, Lubner MG, Muñoz del Rio A, Pickhardt PJ. CT colonography after incomplete optical colonoscopy: bowel preparation quality at same-day vs. deferred examination. Abdom Radiol (NY) 2016; 41:10-8. [PMID: 26830606 DOI: 10.1007/s00261-015-0595-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To objectively compare the volume, density, and distribution of luminal fluid for same-day oral-contrast-enhanced CTC following incomplete optical colonoscopy (OC) vs. deferred CTC on a separate day utilizing a dedicated CTC bowel preparation. METHODS HIPAA-compliant, IRB-approved retrospective study compared 103 same-day CTC studies after incomplete OC (utilizing 30 mL oral diatrizoate) against 151 CTC examinations performed on a separate day after failed OC using a dedicated CTC bowel preparation (oral magnesium citrate/dilute barium/diatrizoate the evening before). A subgroup of 15 patients who had both same-day CTC and separate-day routine CTC was also identified and underwent separate analysis. CTC exams were analyzed for opacified fluid distribution within the GI tract, as well as density and volume. Data were analyzed utilizing Kruskal-Wallis and Wilcoxon Signed Rank tests. RESULTS Opacified luminal fluid extended to the rectum in 56% (58/103) of same-day CTC vs. 100% (151/151) of deferred separate-day CTC (p < 0.0001). For same-day CTC, contrast failed to reach the colon in 11% (11/103) and failed to reach the left colon in 26% (27/103). Volumetric colonic fluid segmentation for fluid analysis (successful in 80 same-day and 147 separate-day cases) showed significantly more fluid in the same-day cohort (mean, 227 vs. 166 mL; p < 0.0001); the actual difference is underestimated due to excluded cases. Mean colonic fluid attenuation was significantly lower in the same-day cohort (545 vs. 735 HU; p < 0.0001). Similar findings were identified in the smaller cohort with direct intra-patient CTC comparison. CONCLUSIONS Dedicated CTC bowel preparation on a separate day following incomplete OC results in a much higher quality examination compared with same-day CTC.
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Affiliation(s)
- Jake Theis
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 750 Highland Avenue, Madison, WI, 53705, USA
| | - David H Kim
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 750 Highland Avenue, Madison, WI, 53705, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 750 Highland Avenue, Madison, WI, 53705, USA
| | - Alejandro Muñoz del Rio
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 750 Highland Avenue, Madison, WI, 53705, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 750 Highland Avenue, Madison, WI, 53705, USA.
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA.
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Moreno CC, Weiss PS, Jarrett TL, Roberts DL, Mittal PK, Votaw JR. Patient Preferences Regarding Colorectal Cancer Screening: Test Features and Cost Willing to Pay Out of Pocket. Curr Probl Diagn Radiol 2015; 45:189-92. [PMID: 26774952 DOI: 10.1067/j.cpradiol.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/12/2015] [Indexed: 12/26/2022]
Abstract
The purpose of this investigation was to evaluate whether test features would make an individual more or less likely to undergo colorectal cancer screening and how much an individual would be willing to pay out of pocket for a screening test. The methods include an administration of a survey to consecutive adult patients of a general medicine clinic. The survey consisted of Likert-scale questions assessing the patients' likelihood of choosing a screening test based on various test characteristics. Additional questions measured the patients' age, race, gender, and maximum out-of-pocket cost they would be willing to pay. Chi-square tests were used to assess the associations between the likelihood questions and the various demographic characteristics. In results, survey response rate was 88.8% (213 of 240). Respondents were 48.4% female (103 of 213), 51.6% male (110 of 213), 82.6% White (176 of 213), 11.3% African-American (24 of 213), and 6.1% other (13 of 213). Risk of internal injury and light exposure to radiation were the least desirable test features. Light sedation was the only test feature that most respondents (54.8%) indicated would make them likely or very likely to undergo a colorectal cancer screening test. The vast majority of respondents (86.8%) were willing to pay less than $200 out of pocket for a colorectal cancer screening test. There was no statistically significant difference in the responses of males and females, or in the responses of individuals of different races or different ages regarding test features, or the amount individuals were willing to pay for a screening test. To conclude, survey results suggest that patient education emphasizing the low complication rate of computed tomographic colonography (CTC), the minimal risks associated with the low-level radiation exposure resulting from CTC, and the benefits of a sedation-free test (eg, no risk of sedation-related complication and no need for a driver) may increase patient acceptance of CTC. Additionally, an out-of-pocket cost of <$200 would be preferable from the patient perspective.
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Affiliation(s)
- Courtney C Moreno
- Department of Radiology & Imaging Sciences, School of Medicine, Emory University, Atlanta, GA.
| | - Paul S Weiss
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Thomas L Jarrett
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA
| | - David L Roberts
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Pardeep K Mittal
- Department of Radiology & Imaging Sciences, School of Medicine, Emory University, Atlanta, GA
| | - John R Votaw
- Department of Radiology & Imaging Sciences, School of Medicine, Emory University, Atlanta, GA
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Cost Differences After Initial CT Colonography Versus Optical Colonoscopy in the Elderly. Acad Radiol 2015; 22:807-13. [PMID: 25890873 DOI: 10.1016/j.acra.2015.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/20/2015] [Accepted: 03/08/2015] [Indexed: 12/15/2022]
Abstract
RATIONALE AND OBJECTIVES To compare differences in Medicare costs 1 year after initial computed tomographic colonography (CTC) or initial optical colonoscopy (OC). MATERIALS AND METHODS We performed a retrospective cohort study of asymptomatic Medicare outpatients aged ≥ 66 years who received initial CTC (n = 531) or OC (n = 17,593) between January 2007 and December 2008; initial OC patients were matched on county of residence and year of screening. Outcomes included differences in total inpatient and outpatient Medicare costs 1 year after initial CTC or OC and differences in outpatient testing of potential findings in the colon, abdomen, pelvis, and lungs. RESULTS Higher adjusted costs per patient were revealed in the year after initial CTC compared to initial OC for outpatient testing related to potential colonic ($50; 95% confidence interval [CI], $12-$88; P = .010) and extracolonic findings ($64; 95% CI, $23-$106; P = .002). However, there were no differences in adjusted total costs per patient in the year after either modality ($2065; 95% CI, $1672-$5803; P = .28). Similarly, adjusted costs did not differ between cohorts for inpatient ($267; 95% CI, $1017-$1550; P = .68) or outpatient care ($2828; 95% CI, $311-$5966; P = .08). CONCLUSIONS Despite higher adjusted costs of outpatient testing potentially related to colonic and extracolonic findings among asymptomatic elderly patients 1 year after initial CTC compared to OC, we found no differences in adjusted total, inpatient, or outpatient costs between cohorts. Although Medicare does not cover screening CTC, our results suggest that these modalities generate comparable downstream costs to payers.
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Hong N, Park SH. CT colonography in the diagnosis and management of colorectal cancer: Emphasis on pre- and post-surgical evaluation. World J Gastroenterol 2014; 20:2014-2022. [PMID: 24587676 PMCID: PMC3934471 DOI: 10.3748/wjg.v20.i8.2014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 12/05/2013] [Accepted: 01/15/2014] [Indexed: 02/06/2023] Open
Abstract
This article addresses the use of computed tomographic colonography (CTC) for the diagnosis and management of colorectal cancer, focusing on presurgical evaluation of the colon proximal to an occlusive cancer and surveillance after cancer resection surgery. The key evidences accumulated in the literature and future work needed are summarized. CTC is a technically robust and the most practical method to evaluate the colon proximal to an occlusive cancer, which prevents colonoscopic examination past the occlusion, either before or after metallic stent placement. The high sensitivity of CTC for detecting cancers and advanced adenomas in the proximal colon can help prevent additional surgical procedures in patients showing negative results. However, the accuracy of CTC for distinguishing intramural cancers from adenomas is low, and the technique is limited in guiding management when a medium-sized lesion that do not show invasive features such as pericolic extension or nodal metastasis is found in the proximal colon. A maximal diameter ≥ 15 mm has been proposed as a criterion for surgical removal of proximal lesions. However, this needs to be verified in a larger cohort. In addition, the influence of presurgical CTC results on the current post-cancer resection colonic surveillance timeline remains to be determined. CTC can be readily added to the routine abdominopelvic CT in the form of contrast-enhanced CTC, which can serve as an effective stand-alone tool for post-cancer resection surveillance of both the colorectum and extracolonic organs. Although the accuracy of CTC has been demonstrated, its role in the current colonoscopy-based postoperative colonic surveillance protocols remains to be determined. Readers of CTC also need to be knowledgeable on the colonic lesions that are unique to the postoperative colon.
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Abstract
Due to advances in technology, magnetic resonance is an increasingly popular method for evaluating the small bowel and colon because of the lack of radiation, wealth of information provided by the images, and growing demand from gastroenterologists, surgeons, and oncologists. Careful attention to proper technique, however, is necessary to obtain high-quality images. Factors that need to be considered for successful magnetic resonance of the bowel include method for administration of oral or rectal contrast, patient positioning, need for antiperistaltic medication, and imaging sequences and planes.
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Affiliation(s)
- Cynthia S Santillan
- Department of Radiology, University of California San Diego, 200 West Arbor Drive #8756, San Diego, CA 92120, USA.
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Cardiac CT and Coronary CTA: Early Medicare Claims Analysis of National and Regional Utilization and Coverage. J Am Coll Radiol 2011; 8:549-55. [DOI: 10.1016/j.jacr.2010.12.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Accepted: 12/29/2010] [Indexed: 11/20/2022]
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