Current articles on ultrasound:
Reimbursement and Payment Advocacy
2009 Update for Medicare payment rates
1.1 percent rate increase for physicians Physicians will see a slight increase in 2009 for the majority of their professional services by the Medicare program. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 provides a rate increase of 1.1 percent to physician payments in 2009.
Higher reimbursement for ultrasound This general increase bumped payment for ultrasound too. For a list of the national average Medicare payments for the ultrasound services you commonly perform, please see our specialty and application specific reimbursement guides.
However, a large drop is slated for 2010 Addressing the large rate reduction in Medicare’s physician fee schedule for 2010 is a priority for Congress. In some previous years, Congress has made cuts to imaging payment rates, including ultrasound’s rates, to fund the update for overall services.
Ultrasound is A Girl's Best Friend
by Marianne Matthews
From the reproductive years to menopause to post-menopause, ultrasound could be dubbed the singular imaging modality that is "a girl's best friend."
"Ultrasound is so wonderful for all areas of the female anatomy because it offers little or no potential to do harm and you get an evaluation in real time," said Pat Whitworth, MD, director of the Nashville Breast Center and immediate past chairman of the board and chairman of the research committee of the American Society of Breast Surgeons.
Today, ultrasound is being utilized effectively and safely for a host of health challenges across the entire scope of female anatomy—breast, vaginal, abdominal—and at every stage of a woman's life. Recent breakthroughs with the modality include exciting findings that validate the value of breast ultrasound for women at high risk for breast cancer as well as inroads in infertility diagnostics and treatment. Here is a look at some of the latest ultrasound innovations.
FIBROID TUMORS: MR-GUIDED FOCUSED ULTRASOUND
Studies show that about 25% of women aged 30 to 50 have uterine fibroids large enough to cause symptoms, and 30% to 50% of women have fibroid tumors that are asymptomatic. In the United States, approximately 2 million women seek care for their fibroids every year. While non cancerous, fibroids are hardly a nonissue to the women who suffer from them. In addition to causing abnormal bleeding and pelvic and back pain, fibroids can interfere with fertility. Surgery for fibroids includes myomectomy and hysterectomy. But women today want options.
That's what MR-guided focused ultrasound (MRgFUS) is all about. "This technology is an alternative to surgery," said Phyllis Gee, MD, FACOG, medical director, North Texas Uterine Fibroid Institute. "Even for women who are not planning to have children in the future, if they don't want to have surgery, it offers another option."
In 2004, the FDA approved MR-guided focused ultrasound for the treatment of fibroid tumors. Essentially, the procedure offers a uterine fibroid ablation therapy—a very precise method of shrinking the tumors. However, the fibroids do not disappear altogether and may indeed eventually grow back. Nonetheless, it's a noninvasive alternative; that means an outpatient procedure with no anesthesia.
The treatment uses a high-intensity focused ultrasound beam to heat and destroy targeted tissue coupled with MRI to visualize patient anatomy and control the treatment by monitoring the tissue effect in real time.
Explaining the process, Gee says it's all about focusing energy on the tumor. The MR allows the clinician to see into the body and evaluate what needs to be treated. "You get 3D pictures of pelvic organs—hundreds of cuts," Gee said. The transducer—which Gee calls "key"—is built into the MR table and directs a target of energy at the tumor(s). Once it is targeted, the MR equipment provides "real-time feedback of the treatment. Within 3 to 5 seconds, we get a temperature curve and know when we've reached a critical temperature to destroy the tumor," Gee said .
"It is very precise. You can visualize the anatomy and monitor what's going on with the tissue," Gee said . "So you are able to control the treatment."
Gee is a big proponent of MRgFUS. "It's very exciting and very rewarding work," said Gee. "A woman walks in the door and walks out 60 to 90 minutes later. Typically, within 3 months, she experiences significant symptom improvement." That's a lot faster—and easier—than surgery. But does the procedure work efficiently … and on whom?
According to experts, the ideal candidate for MR-guided focused ultrasound is a woman with one to four moderately sized fibroids, ranging from 4 to 6 cm. For the treatment to work, the tumors must be of a specific type. Subserosal fibroids, which are located on the outer surface of the uterus, do respond to MRgFUS. But MRgFUS cannot treat pedunculated tumors—which Gee likens to "a piece of broccoli, where the fibroid is the flower part."
IMS Research medical research division InMedica has released a report predicting that worldwide revenues of the global ultrasound market will continue to enjoy growth and exceed $6 billion by 2012, even amidst the current economic downturn.
Researchers cite the ultrasound markets’s flexibility, ease of use and relatively low cost as reasons for continued growth. They also noted a trend to “miniaturization” and the popularity of hand-carried ultrasound equipment.
While the ultrasound market adoption was significantly quicker in North America and Western Europe, an increasing confidence in hand-carried systems has made its way around the globe to other regions of the world, such as Eastern Europe, Latin America and parts of the Asia Pacific.
Demand is coming from traditional applications, such as OB/GYN, and increasingly from point-of-care applications using portable ultrasound systems.
“The global ultrasound market is being driven by the need to maximize space, time and efficiency and hand-carried systems are evolving to adapt to any given environment,” reported Diane Wilkinson, Market Research Analyst at InMedica. “This can be seen by an increase in the number of hand-carried products designed for specific applications, such as nerve blocking, musculoskeletal and breast imaging.”
Researchers say the economic downturn is favoring the lower end of the cart-based ultrasound equipment market.
In this segment, the greatest growth is found in the mid-range segment, and there is a higher than usual growth forecast for the low-end segment, particularly in 2009.
Furthermore, the report indicates movement away from very high-end systems due to the increasing functionality and picture quality of systems at the lower end. With the improvement in quality and functionality of lower end systems, prices are stabilized in an otherwise price competitive market.