Some legislation we can all get “behind” – CT Colonography Screening

CT Colonography Screening Bill

On February 25, a new bill with bipartisan support was introduced in Congress. If passed, H.R. 4632—also known as the CT Colonography Screening for Colorectal Cancer Act of 2016—would provide Medicare coverage for seniors who choose to be screened with CT colonography (virtual colonoscopy) instead of traditional colonoscopy.

“Early screening for colorectal cancer saves lives. Unfortunately, too many Americans fail to get screened because they feel current procedures are too invasive, or can’t for medical reasons. By covering an additional method of screening, Medicare can give seniors and physicians another tool for preventive and lifesaving care,” says Ben Wenstrup (R-OH), co-sponsor of the bill along with Danny Davis (D-IL).

It is widely known that 75% of those at risk for colon cancer fail to get screened; some speculate this is because of the invasive or embarrassing nature of the traditional colonoscopy. My theory is that the traditional screening is too complex and expensive. Unlike a mammogram or an ultrasound, where the individual can simply drive to the imaging center and then drive home an hour later, colonoscopy requires sedation, which forces the individual being screened to have to ask someone to drive them to and from the endoscopy center. The colon cleans prep is also heavier, and is commonly cited as the worst part of the entire procedure. The whole episode creates a major disruption to a person’s normal routine and diet. Finally, the price of a colonoscopy can range from $2,500 to more than $8,000. For individuals under 65 with high deductible plans, this can be expensive.

All of that adds up to…procrastination.

But CT colonography is a more practical test. Requiring only a light prep, it is essentially a CT scan of the colon. It can see areas of the colon the traditional colonoscope may not be able to reach (e.g. the cecum, which is the beginning of the colon). And it’s much less expensive, usually under $1,000.

In fact, a recent study* demonstrated that screening patients over 65 with CT colonography would cost 29% less than the traditional test and save up to $1.7 billion per screening cycle. Many private insurers now cover CT colonography, probably because at least 20 states have laws requiring them to do so.

Today, many of the individuals over 65 who undergo CT colonography are not able to have the traditional scope for various reasons. This could be due to their anatomy (which can make endoscopy challenging), or if they are on blood thinners (and are therefore at risk for internal bleeding).

Opponents—who typically consist of the greater gastroenterology community—complain that if CT colonography detects a polyp, it provides no means to remove it for testing as the traditional colonoscopy procedure does.

They’re missing the point. 90% of colon cancer death is preventable. Three-quarters of those at risk avoid their screenings, despite the best efforts of the medical community to inform patients. Clearly, another approach is needed.

What’s more, less than 8% of colonoscopies reveal polyps that would be considered suspicious. Wouldn’t it be better for an individual to actually get screened in the first place than worry about whether or not they will be inconvenienced by a follow-up test?

Here’s an idea for the GI community: Partner with your local imaging provider. We can assume that the majority of the unscreened (75% of people over 50) don’t actually have a gastroenterologist. But more widespread screening will reveal more patients at risk, and those patients will need a specialist. Instead of fighting this test, embrace it, and see it for the opportunity it really is—a chance to build your patient base while saving lives. How is that not a win-win situation all around?

March is colorectal cancer awareness month. What can you do? Write your representatives and tell them to support H.R. 4632. Let them know you’re behind this test. And together, we can do our part to eliminate colorectal cancer as a leading cause of death in the United States.



(*) Abdominal Imaging October 2015, Volume 40, Issue 8, pp 2966-2976 First online: 09 September 2015 Medicare cost of colorectal cancer screening: CT colonography vs. optical colonoscopy Bruce Pyenson, Perry J. Pickhardt, Tia Goss Sawhney, Michele Berris 10.1007/s00261-015-0538-1


What’s missing from National Heart Month?

National Heart Month

Last October, advocates of Breast Cancer Awareness Month encouraged women to get mammograms. The rationale: early detection saves lives. This past November marked the first time advocates of National Lung Cancer Awareness Month could encourage those at risk for lung cancer to request a low-dose CT scan of the lungs from their doctors. Since the CMS decision to cover lung screening for Medicare patients early in 2015, the test is now widely used to achieve—you guessed it—early detection of lung cancer.

But what test are the advocates of American Heart Month advising? The American Heart Association wants you to “learn the warning signs for heart attack and stroke.” Million Hearts® is “challenging men to start one new, heart-healthy behavior.” AHA’s Go Red For Women® wants you to “end heart disease and stroke in women” by wearing a red dress on February 5.

Do you honestly believe the actions of these non-profits during American Heart Month will have any effect on the rate of heart disease and heart attacks in the United States? Consider the fact that heart disease is a costly epidemic in America, currently responsible for 17% of national health expenditures and projected to triple in cost by the year 2030. Consider that by 2030, 40.5% of the U.S. population is projected to have some form of cardiovascular disease according to the American Heart Association’s own forecast.* Although some might point to a recent decline in heart disease deaths among seniors, mortality rates for women and those under 55 are not improving. What’s more, one-third of all first heart attacks are fatal.

Suspiciously absent from the dialog is the recommendation of any test that could achieve the early detection of heart disease. But one exists, and it’s been largely ignored by the greater medical community for more than two decades.

In 1993, San Francisco-based Imatron, Inc. made available to the public an ultrafast electron beam CT scanner capable of accurately imaging a beating heart, with a low radiation dose and a highly accurate picture of coronary artery calcification. Dr. Arthur Agatston—the cardiologist who would subsequently write the best-selling book The South Beach Diet—was instrumental in the early research on the coronary calcium score and developed the calculations assigned to the density of calcification in the coronary arteries.

In 2005, St. Francis Heart Hospital in Roslyn, New York, released the results of what became known as the St. Francis Heart Study in the July 5 edition of the Journal of the American College of Cardiology. The study of nearly 5,000 healthy patients demonstrated that the coronary calcium score predicted coronary “events” such as heart attack independently of, and more accurately than, conventional risk factors such as age, smoking, blood pressure, cholesterol and C-reactive protein.

Calcium ScoreIn August of 2012, a new study of intermediate risk patients lead by Dr. Joseph Yeboah, assistant professor of internal medicine-cardiology at Wake Forest Baptist Medical Center, found that widespread use of the coronary calcium score would have accurately “reclassified” 25% of individuals from intermediate to high risk, and another 40% would have been reclassified to low risk.

This meant that the current “gold standard” of coronary risk stratification—the Framingham score—was incorrect in its classification of more than half of people labeled as having intermediate risk.

Translated into English: The coronary calcium score works far better than the Framingham model at identifying those at risk of heart disease. These studies—and dozens more like them—proved that the coronary calcium score was the best non-invasive test for the early detection of heart disease in otherwise healthy individuals.

So why isn’t this test embraced and recommended by the medical establishment? Why doesn’t your primary care doctor recommend the heart scan to men over 40 and women over 45 every few years?

“CAC scoring is a poor bargain with high costs and real harms,” said Dr. Steven Nissen, chairman of cardiology at the Cleveland Clinic Foundation. “Calcium scoring has become a cult. It is widely advertised, and in Southern California there were once billboards encouraging people to go in and get their coronary arteries scanned, which can expose them to other risks, such as high levels of radiation. Yet there are absolutely no data [showing] that screening people for calcium with CT scanning affects their outcome in terms of survival.”

Calcium score naysayers like Nissen say that there are no randomized clinical trials that demonstrate that tests like the heart scan will ultimately reduce the number of heart attack deaths. He’s technically correct. However…there are also no randomized clinical trials that demonstrate the stress test will reduce the number of heart attack deaths—and that test is widely accepted as a “gold standard.” Nor are there such studies for many other lifesaving medical tests, such as breast MRI.

In fact, there is no randomized clinical trial that demonstrates jumping out of an airplane without a parachute causes death. But when we apply common sense, we see that we don’t really need such a study.

“For so long we’ve been doing it wrong,” says Matt Budoff, M.D., a cardiologist affiliated with UCLA Medical Center and one of the nation’s leading advocates of the calcium score. “There’s a very famous Chinese saying from the very first medical text that says that superior doctors prevent the disease, inferior doctors treat the full blown disease. I think we have been inferior doctors in cardiology for quite a long time. We have been waiting for heart attacks, we’ve been waiting for chest pain, we have been waiting for patients literally to suffer sudden death to jump in there with guns blazing and catheters interacting and trying to save them rather than getting to them earlier before the first event.”

Budoff’s research was instrumental in helping to achieve new American College of Cardiology (ACC) guidelines—released in 2013—that call for the use of calcium scoring to help better stratify risk in patients.

“The studies suggest that we may have been underestimating the value of calcium scoring for detecting and managing patients with known or suspected coronary disease,” says Kima Allan Williams Sr., M.D., vice president of the ACC and chief of cardiology at Rush University Medical Center in Chicago.

So, if the calcium score is a far better test to achieve early detection of heart disease than any other available test—cholesterol, blood pressure, etc—or risk stratification model, such as Framingham, why are organizations like the ACC so late to the game in advocating it?

Ironically, Dr. Steven Nissen was heavily involved with the ACC throughout the last decade, even serving as president of the organization. In 2007, Time magazine named him one of the 100 Most Influential People in the World. With that kind of clout and respect from the establishment, it’s safe to say that his opposition to the test—despite its clinical viability—has had an effect.

Still, you’ll find that many hospitals, diagnostic imaging centers and large cardiology practices offer the coronary calcium score test—usually at a cost of about $100.

My advice to you during American Heart Month is to pony up that C-note and get yourself screened so that you can achieve early detection if you have heart disease. Isn’t that the whole point of an awareness month anyway?



*Forecasting the Future of Cardiovascular Disease in the United States. A Policy Statement From the American Heart Association


Armada Team Members Selected as Featured Speakers at the 2016 Radiology Business Management Association Conference in Las Vegas

Featured Speakers

Three—count ‘em—three of Armada’s medical marketing experts will present, as featured speakers, on a variety of marketing communications topics at this year’s RBMA Building Better Radiology Marketing Programs conference March 6-8 in Las Vegas.

Jennifer Crump-Bertram and Sara Ross will co-present the topic: “Feet, Sweets or Tweets: What Are The Most Effective Components of a Marketing Communications Program?” The presentation is aimed at helping radiology providers determine if they need a brand strategy, how to use the internet to market a practice, the importance of timing in direct-to-patient campaigns, social media strategies and more.

Jim Koehler will lead a presentation entitled “How to Get the Greatest Value out of Your Marketing Resources.” It will cover such topics as how to set a realistic marketing budget, how to evaluate creative concepts in advertising and physician marketing and how to best demonstrate ROI and the value of marketing to executive management.

The presentations comprise the bulk of the pre-conference session designed to help radiology administrators and marketing directors learn new and proven techniques to more effectively market radiology practices, hospital imaging departments, independent diagnostic testing facilities and women’s imaging centers.


Armada Brings Home the Gold from the Colorado Healthcare Communicators 2015 Gold Leaf Awards

Gold Leaf AwardsArmada Medical Marketing is honored to have been awarded a prestigious Gold Leaf and Silver Leaf Award from the 2015 Colorado Healthcare Communicators Gold Leaf Awards. The Armada team earned the Gold Leaf Award in the media relations category for media coverage secured in key outlets for the product launch of FORE Support Services’ AuthPal cloud-based prior authorization software for radiology practices.

Armada crafted a press release to announce the launch of this first-of-its-kind product and then used our extensive relationships within the radiology, and health care IT, and revenue cycle management space to secure coverage of the product’s launch at the 2015 Radiology Business Management Association’s Radiology Business Summit in Las Vegas this past June.

Judges’ comments on this powerful campaign included: “This product launch is a flawless new product launch media relations effort. It combines pre- and post-event communications and content creation to create a community of interest and actual product inquiries,” “Thoughtful and strategic messaging incorporated for each of the (campaign) phases and media channels,” and “…the validated responses, robust media coverage and engagement with the target market was a phenomenal achievement.”

We’re also very excited to have won a Silver Leaf Award in the single platform social media category for a Movember fundraising and men’s health awareness campaign we orchestrated for Synergy Radiology Associates last November. Armada recommended that Synergy conduct a Facebook fundraising campaign supporting the Movember USA Foundation, which raises awareness and research funds for prostate and testicular cancer by encouraging men to grow a moustache throughout the month of November. The growing moustache acts as a visual conversation starter and reminder about the importance of men’s health issues.

Six Synergy radiologists started the month clean-shaven and then sent in weekly photos of their moustache’s progress, which were shared on Synergy’s Facebook page. Fans of Synergy’s page voted for their favorites by clicking the like button. For every like a photo got, Synergy donated a dollar to the Movember USA Foundation, raising a total of $1,000. The campaign also increased Synergy’s social media fan base by attracting nearly 400 people to like and follow the radiology group’s Facebook page and engage in meaningful conversations about men’s health.

Judges’ comments included: “Great results on a single medium,” and “This is a great campaign and great use of a single platform for a B2B audience.”

Thanks to Colorado Healthcare Communicators for putting on another great event, and congratulations to all of this year’s award winners!


Medicare Sustainable Growth Rate Formula Gets Permanent Fix

The dreaded sustainable growth rate (SGR) formula, and the numerous temporary “doc fixes” associated with it, has finally been “fixed.” This fix means the SGR has been replaced with a permanent legislative solution. The new legislation passed by Congress and signed into law effectively ends the SGR formula used to create the Medicare physician fee schedule, replacing it with a permanent reimbursement plan and value-based care incentives.

Implemented in 1997, the SGR is a formula designed to limit growth of Medicare Part B spending by linking changes in reimbursement to the growth of the U.S. economy as a whole. Since that time, proposed cuts in the SGR have been delayed 17 times by so-called “doc fix” bills, with short-term fixes often paid for through physician payment reductions. Diagnostic imaging, for example, was particularly hard hit, with advanced diagnostic imaging services such as CT, MRI and PET/CT experiencing repeated payment reductions. These temporary fixes simply delayed the inevitable while increasing financial pressures and uncertainty for health care providers.

No matter how one feels or what one knows about “the fix,” what it brings to medical practices, including radiology groups and imaging centers that medical marketers work with every day, is stability and predictability. Not surprisingly, the bureaucratic complexity and questions of implementation remain. This does, however, quell the economic storm that has been swirling around the SGR for the past 17 years.

Without the permanent fix, the Centers for Medicare and Medicaid (CMS) was planning a predicted 21 percent cut in Medicare reimbursements. With the repeal and replacement of the old methodology, regulators have developed a new payment model that incorporates a base fee increase of .5% to the Medicare fee schedule annually over next 5 years, with bonuses for quality care improvements and patient centered medical home participation. At that point, individual physicians could earn incentive payments through either an Alternative Payment Model (APM) program or the new Merit-Based Incentive Payment System (MIPS).

Starting in 2019, CMS will establish MIPS as part of its efforts to move from a fee-for-service payments system to a value-based system. The MIPS payment program assesses the performance of each eligible provider based on quality of care, resource use, clinical practice improvement and meaningful use of electronic health record technology.

Medicare physician payment rules and guidelines remain extraordinarily complex, and a myriad of policy details remain to be worked out. However, the bottom line for the medical community is that a stable Medicare fee schedule will result in a positive effect on the revenue cycle and payments, allowing more accurate and successful business planning and marketing.

Sources and resources: 

H.R.2 – Medicare Access and CHIP Reauthorization Act of 2015

The most important details in the SGR repeal law

A primer on Medicare physician payment reform and the SGR

Obama Signs SGR Repeal Legislation; Value-Based Payment Model Comes Into Full Force in 2019



And the Oscar goes to: Neurological Disease Awareness

oscars neurological diseaseAcademy Award winners often use their acceptance speeches to make us aware of causes that are near and dear to them, and this year was no exception.

In 1993, Richard Gere used the forum to bring awareness to human rights violations in Tibet. In 2009, Sean Penn used his acceptance speech to promote same-sex marriage. Perhaps the most famous example is when Marlon Brando sent a surrogate to accept the Best Actor award for his role in The Godfather in 1973. Native American civil rights activist Sacheen Littlefeather accepted the award and used the occasion to make a speech intended to bring awareness to the American Indian Movement.

But this year, the content of the nominated films and that of the acceptance speeches were very much in sync, and for the best actress and best actor award winners, the focus was on neurological disease.

In “Still Alice,” Julianne Moore plays a college professor experiencing the symptoms of early-onset Alzheimer’s disease. According to The Alzheimer’s Association, the disease affects an estimated 200,000 people in the U.S. each year, including people in their 40s and 50s.

In “The Theory of Everything,” Eddie Redmayne portrays the celebrated physicist Stephen Hawking through his younger years as amyotrophic lateral sclerosis (ALS) begins to rob him of his speech and use of his body. “This Oscar belongs to all of those people around the world battling ALS,” he said during his acceptance speech.

According to The Neurological Alliance, “Neurological conditions are very poorly understood by the general public.” The FDA believes that disease awareness communications “can provide important health information to consumers and health care practitioners, and can encourage consumers to seek, and healthcare practitioners to provide, appropriate treatment. This is particularly important for under-diagnosed, under-treated conditions.”

Social media has been an important factor in the proliferation of neurologic disease awareness. Last summer’s ALS “Ice Bucket Challenge” was started as a grassroots effort that soon caught fire on social media and was then picked up by mainstream national media. This year’s Oscars had the reverse effect, beginning with a mainstream media event and then exploding on social media. For example, Julianne Moore’s acceptance speech produced 64,764 social media mentions during the broadcast, including 8,040 that mentioned Alzheimer’s specifically.

With several hundred million worldwide viewers in more than 200 countries around the world, it’s very likely that awareness of these devastating neurological diseases will continue to grow.


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