Why cardiac CT adoption remains low among primary care providers

“We’re thrilled with the CMS’s ruling, which better aligns with the cost of providing CCTA services,” Ahmad Slim, MD, chair of the SCCT Health Policy and Practice Committee, said at the time. “This is a huge win for U.S. providers as well as the entire cardiac imaging community, ultimately improving patient access to this essential diagnostic tool, which aligns with the society’s overall mission.”

Primary care providers slow to adapt

As CCTA continues to grow in importance, it remains significantly underutilized by primary care providers. Survey data suggests they are much more likely to turn to echocardiography or treadmill stress testing to evaluate a patient for chest pain or other potential heart issues than they are to order CCTA. 

With this in mind, the team behind the JCCT editorial highlighted six factors that may help explain why primary care providers are not yet on board with cardiac CT.

6 potential barriers to CCTA utilization

1. Knowledge gaps

The JCCT editorial noted that many of the education and advocacy efforts intended to increase CCTA utilization have been focused on cardiologists and cardiac imagers, not primary care providers. For this reason, they wrote, these physicians may need help catching up with the latest data and recognizing how important this modality is for the health of their patients. 

“Education and advocacy focused on the frontline of healthcare, our primary care base, are lacking,” wrote lead author Ashton Sequeira, MD, an internist with the University of South Florida Morsani College of Medicine, and colleagues.

For example, the authors pointed to one recent survey that found 57% of primary care providers were unsure about which patients should be selected to undergo CCTA. If more of these physicians can learn more about the patient selection process, it should directly lead to an increase in utilization.

2. Scanner availability

“Access to CT scanners with qualified readers further limits adoption in clinical practice,” the authors wrote. “From 2007 to 2021, the number of total CT scanners in the U.S. increased meagerly from 34.3 to 42.6 CT scanners per 1 million people, and in the ambulatory setting, increased from 10.4 to 15.6 CT scanners per 1 million people. Economic forces have also shifted cardiologist office-based scanning to hospital outpatient departments, where CCTA reimbursement is higher.”

3. Radiation concerns

4. Coverage limitations

5. RBM and PA programs

“Radiology benefits management and prior authorization programs function as secondary filters, determining the specific indications for which a test may be obtained, often independent of overriding clinical factors or clinician decision-making,” the authors wrote. “These processes result in back-office inefficiency, medical errors and delays in care.”

6. Wait times

CCTA reimbursement is often higher when it occurs at an outpatient imaging facility, but sending patients away from the hospital can make it a more difficult process that takes longer. This can leave primary care providers wanting to choose another evaluation option altogether.

National societies can help

Sequeira et al. believe the SCCT and other medical societies can help overcome these barriers by continuing to education physicians and advocating lawmakers for more CT-friendly payment policies. The patient education piece is particularly vital if primary care providers are ever going to evolve. 

“As the saying goes, knowledge is power, and empowering our primary care colleagues will continue to drive a ‘CT first’ approach,” the group concluded. 

Click here to read the team’s full editorial.