Why Cardiac CT Adoption Remains Low Among Primary Care Providers
Why Cardiac CT Adoption Remains Low Among Primary Care Providers
Published by: Journal of Cardiovascular Computed Tomography (JCCT) | Date: February 28, 2025
Overview
Despite the rapid advancements in coronary CT angiography (CCTA), primary care providers (PCPs) have been slow to adopt a CT-first approach in evaluating heart conditions. A recent editorial in the Journal of Cardiovascular Computed Tomography (JCCT) explores the reasons behind this hesitation and suggests ways to encourage adoption.
The Rise of CCTA
• CCTA has emerged as a noninvasive diagnostic tool for coronary artery disease (CAD).
• It received a Class 1A recommendation from:
• The European Society of Cardiology (2019) for suspected CAD.
• The American Heart Association (AHA) and American College of Cardiology (ACC) (2021) for acute chest pain.
• In late 2024, the U.S. Centers for Medicare and Medicaid Services (CMS) increased Medicare reimbursements for CCTA, improving financial viability for hospitals.
Challenges Preventing Adoption by Primary Care Providers
The JCCT editorial identified six major barriers:
1. Knowledge Gaps
• Many education efforts have targeted cardiologists, not PCPs.
• A survey found 57% of PCPs were unsure about patient selection for CCTA.
2. Limited Scanner Availability
• From 2007 to 2021, the number of CT scanners per million people in the U.S. increased only slightly from 34.3 to 42.6.
• Many cardiology practices have shifted scanning to hospital outpatient departments due to higher reimbursement rates, making access more challenging.
3. Radiation Concerns
• Some PCPs remain hesitant due to potential radiation exposure from CT imaging.
4. Coverage Limitations
• Insurance and reimbursement policies may not always cover CCTA for all indications, leading PCPs to choose alternative tests like echocardiography.
5. Radiology Benefits Management (RBM) and Prior Authorization (PA) Programs
• These programs restrict test approvals and often create delays, inefficiencies, and medical errors.
6. Long Wait Times
• CCTA is often performed in outpatient imaging centers for higher reimbursement, but longer scheduling times may discourage PCPs from choosing it.
Potential Solutions: The Role of Medical Societies
• The Society of Cardiovascular Computed Tomography (SCCT) and other organizations should:
• Educate PCPs on CCTA’s benefits and appropriate use.
• Advocate for policy changes to improve insurance coverage and reimbursement.
• Improve patient education, as informed patients may request CCTA when appropriate.
Conclusion
The adoption of CCTA by primary care providers remains low despite its proven benefits. By addressing knowledge gaps, improving accessibility, and refining insurance policies, the medical community can promote a CT-first approach, enhancing early detection and management of heart disease.
For the full editorial, visit the Journal of Cardiovascular Computed Tomography (JCCT)
https://www.journalofcardiovascularct.com/home