Reimbursement for chest-pain CT: estimates based on current imaging strategies

The purpose of this study was to estimate reimbursement for chest pain CT, assuming no cost increase for current emergent chest pain imaging. Using reported imaging test characteristics, prevalence and risk of coronary heart disease, and Medicare reimbursement schedules, 10,000 simulated patients were evaluated with three chest pain imaging algorithms. The main difference among the algorithms was the initial imaging tool: stress echocardiography, single photon emission computed tomography (SPECT) and chest pain CT. Outcome analysis included deaths, intra- and extra-hospital myocardial infraction, number of tests performed, time utilization, and the cost per patient. The chest pain CT algorithm was assessed with its reimbursement as an unknown to determine a maximum reimbursement that would not increase overall healthcare costs. Stress echocardiography costs $856.5 per patient with 8.4 observation hours and 646 (27%) negative catheterizations. When SPECT replaces stress echocardiography, the cost increases to $1,413.7 with average observation of 9.05 hours and 1,060 (36%) negative catheterizations. Chest pain CT minimizes observation (by 8.4 and 9.1 compared to echocardiography and SPECT, respectively); negative catheterizations drop to 266 (12%). Solving for chest pain CT reimbursement as an unkown yields $433.1 and $990.3 when compared to echocardiography and SPECT, respectively. Under the assumption that new technology should not increase overall imaging costs, reimbursement for chest pain CT is compatible with current reimbursement for pulmonary embolism and aortic dissection CTA. Reimbursements must be weighed against the complexity and patient benefits of the examination.