How I Do It: Judging Appropriateness for TTE and TEE
How I Do It: Judging Appropriateness for TTE and TEE
While the risk of harm with inappropriate intervention was an important motivator to the application of AUC, the focus on appropriate use in imaging is mainly rooted in resource utilization and medical expenditure. The contribution of imaging to the medical budget started to be highlighted in the United States >20 years ago. At this time, the Medicare Payment Advisory Commission (MedPAC) showed a 10%/year increase of spending for cardiac imaging between 1999 and 2002, when the average growth per year of all services was 5.2%. This continued throughout the following decade – imaging payments to Cardiologists in 2000 were US$1.6 billion, increasing to US$5.1 billion in 2006. Contributors to this growth included the rapid proliferation of imaging machines, limited experience with new imaging modalities among non-specialists, automated referral pathways, poor quality of imaging (requiring repetition) and defensive medicine. Differences in the use of imaging among regions supported the contention that the selection of imaging test was discretionary rather than disease-related (Figure 1).
(Enlarge Image)
Figure 1.
Differences in the use of echocardiography in the US in 1996. Regional variations by hospital referral region, expressed as a ratio to the US average. From Wennberg D, et al. The Dartmouth Atlas of Cardiovascular Health Care. P65. 1999 [11].
Motivations to the Definition of Appropriate Use Criteria
While the risk of harm with inappropriate intervention was an important motivator to the application of AUC, the focus on appropriate use in imaging is mainly rooted in resource utilization and medical expenditure. The contribution of imaging to the medical budget started to be highlighted in the United States >20 years ago. At this time, the Medicare Payment Advisory Commission (MedPAC) showed a 10%/year increase of spending for cardiac imaging between 1999 and 2002, when the average growth per year of all services was 5.2%. This continued throughout the following decade – imaging payments to Cardiologists in 2000 were US$1.6 billion, increasing to US$5.1 billion in 2006. Contributors to this growth included the rapid proliferation of imaging machines, limited experience with new imaging modalities among non-specialists, automated referral pathways, poor quality of imaging (requiring repetition) and defensive medicine. Differences in the use of imaging among regions supported the contention that the selection of imaging test was discretionary rather than disease-related (Figure 1).
(Enlarge Image)
Figure 1.
Differences in the use of echocardiography in the US in 1996. Regional variations by hospital referral region, expressed as a ratio to the US average. From Wennberg D, et al. The Dartmouth Atlas of Cardiovascular Health Care. P65. 1999 [11].
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