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Law to reduce unneeded Medicare CT, MR exams delayed by Trump administration

by Thomas Dworetzky, Contributing Reporter | August 14, 2019

"For the most part, doctors are well trained and know exactly what tests to perform," Robert Tennant, director of health information technology for the Medical Group Management Association, told KHN. The group, which represents physician groups, has been urging Congress to repeal the provision.

The American College of Radiology, one of the medical organizations and health systems with CMS approval to create guidelines, hopes “to get ahead of the train and come up with a policy that was preferable to prior authorization,” its Executive Vice President Cynthia Moran told the news agency.

While clear guidelines are one approach to cutting down on unneeded scanning, technology may provide other paths as well.

In July, a new study showed that over 30 percent of head CT scans could be avoided with the use of the FDA-cleared BrainScope One medical device.

“Greater than 80 percent of patients who arrive at the emergency department with a mild traumatic brain injury (mTBI) will be scheduled for a CT scan to rule out a structural injury. On average, mTBI patients who receive a CT scan spend approximately 6.6 hours in the ED, including a 2.5 hour waiting period for the scan to be performed and assessed by a radiologist,” BrainScope CEO Michael Singer told HCB News. “Ninety-one percent of these scans are negative, exposing the patient to unnecessary radiation. Additionally, a CT scan does not indicate the presence or severity of concussion, resulting in many concussed patients being discharged with little or no follow-up.”

The handheld system uses AI to triage head-injured patients between those likely CT positive and those CT negative for structural brain injury.

“BrainScope One may be used in the future to help identify those patients who may need advanced neuroimaging (for example MR), who might be found to be CT-, but who have suffered a brain injury,” noted Singer, adding, “this would help to better, cost-effectively determine who needs imaging and what type of imaging, which could help ensure clinically appropriate scanning decisions.”

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