Rolling With The (CCTA) Punch

Image credit: http://www.heartandmetabolism.org

NightHawk Radiology is the premier remote reading operation in the US. Based in Coeur D'Alene, Idaho, it started life as a night hawk call service(surprise) and has morphed (or metastasized, depending upon your point of view) into something more (from a CNN.com report):

(NightHawk) is leading the transformation of the practice of radiology by providing high-quality, cost-effective services to radiology groups and hospitals throughout the United States. NightHawk provides the most complete suite of solutions, including professional services, business services, and its advanced, proprietary clinical workflow technology, all designed to increase efficiencies and improve the quality of patient care and the lives of physicians who provide it. NightHawk's team of U.S. board-certified, state-licensed, and hospital-privileged physicians located in the United States, Australia, and Switzerland, provides services 24 hours a day, seven days a week, for more than 750 radiology group customers and the 26% of all U.S. hospitals they serve.

Rather impressive. So impressive, in fact, that it was selected to read exclusively for the High-Risk Plaque Initiative. NightHawk will read "Chest CT's" for approximately 6,000 participants. No doubt some of these subjects will get more than one CT over the course of the study. Why NightHawk?

"NightHawk was chosen because it was the single teleradiology provider with the strategic experience managing the complex technical aspects and reporting requirements of CCTA reconstructions," said Cherrill Farnsworth, President and Chief Executive Officer of HealthHelp, a radiology benefit management company that is coordinating the teleradiology aspect of the HRP Initiative. "NightHawk's resources, flexibility, and expertise place them at the forefront of CCTA and the 3D reconstruction. They are the only global provider with a viable solution that is available today."

Now why, do you suppose, am I reporting this with my tongue approaching my cheek? Perhaps you have heard about CMS/Medicare's proposal to

. . .eliminate all Medicare reimbursement for coronary CTA save for two indications, further stipulating that coronary CTA must be performed within the confines of a controlled clinical trial to be reimbursed.

The wisdom (or lack thereof) of this limitation has been debated ad nauseum, and I smell an attempt by CMS to thwart cardiologists from buying and (ab)using CT scanners. Of course, they won't state this for the record, but you can bet someone in Baltimore thought of it.

I certainly applaud NightHawk's interest in validating CCTA in this setting. The data needs to be produced and in the end it might be better for a relatively homogeneous group to do the reading. But you just have to admire them for getting paid to read those 6,000 plus scans, when those who have been in the trenches doing CCTA on a clinical basis for quite a while, such as Dr. David Dowe of Atlantic Medical Imaging, might get bupkis. I guess that's the way the plaque crumbles, eh?