SCMR Statement on Violence and Societal Oppression

The Society for Cardiovascular Magnetic Resonance (SCMR) is deeply concerned about escalating instances of violence and oppression that profoundly impact our communities and world.   

As a global Society representing physicians, scientists, technologists, educators, and medical practitioners, SCMR rejects and condemns any form of aggression, violence, and societal oppression and supports those who are victimized, alienated, or marginalized, and freedom of choice.

SCMR believes in the right of all persons to live without fear of violence, oppression, or freedom of expression regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, or veteran status.

These values are enshrined in the SCMR Equality, Diversity, and Inclusion Statement.

We are continuing to analyze the OPPS proposed rule for additional policy changes that will impact the provision of CMR services. Check www.scmr.org for updates.


Medicare Physician Fee Schedule
Conversion factor
The proposed calendar year (CY) 2021 PFS conversion factor is $32.26, a decrease of $3.83 from the CY 2020 PFS conversion factor of $36.09. This is due to policy changes required by law. Along with revisions in the coding structure for certain services (evaluation and management services), this means that some specialties, such as radiology, could see professional component reimbursement cuts up to -11 percent.

Initial calculations for CMR services under the proposed PFS are:

Merit-based Incentive Payment System (MIPS)
CMS proposes the following category weights for the 2021 performance period (CY 2023 payment year). The maximum negative payment adjustment would be -9 percent.

• The Quality performance category to be weighted at 40% (5% decrease from 2020)
• The Cost performance category to be weighted at 20% (5% increase from 2020)
• The Promoting Interoperability performance category to be weighted at 25% (no change from 2020)
• The Improvement Activities performance category to be weighted at 15% (no change from 2020) 

For cardiology quality measures, CMS proposes to reassess the appropriateness of individual measures, on a case-by-case basis, to ensure appropriate inclusion in the cardiology specialty set. Of note, CMS proposes to retain these previously finalized measures that pertain to CMR.

Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Preoperative Evaluation in Low- Risk Surgery Patients: Percentage of stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), stress echocardiogram (ECHO), cardiac computed tomography angiography (CCTA), or cardiac magnetic resonance (CMR) performed in lowrisk surgery patients 18 years or older for preoperative evaluation during the 12-month submission period. Measure steward is ACCF.

 

Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Routine Testing After Percutaneous Coronary Intervention (PCI): Percentage of all stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), stress echocardiogram (ECHO), cardiac computed tomography angiography (CCTA), and cardiovascular magnetic resonance (CMR) performed in patients aged 18 years and older routinely after percutaneous coronary intervention (PCI), with reference to timing of test after PCI and symptom status. Measure steward is ACCF.

Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Testing in Asymptomatic, Low-Risk Patients: Percentage of all stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), stress echocardiogram (ECHO), cardiac computed tomography angiography (CCTA), and cardiovascular magnetic resonance (CMR) performed in asymptomatic, low coronary heart disease (CHD) risk patients 18 years and older for initial detection and risk assessment. Measure steward is ACCF.

For More Information

For a fact sheet on the CY 2021 Physician Fee Schedule proposed rule, please visit:
https://www.cms.gov/newsroom/fact-sheets/proposed-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-4  

For a fact sheet on the CY 2021 Quality Payment Program proposed rule, please visit: https://protect2.fireeye.com/url?k=4b7fae8b-172bb7f7-4b7f9fb4-0cc47adc5fa2-dd9a6042df9c69d5&u=https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1100/2021%20QPP%20Proposed%20Rule%20Fact%20Sheet.pdf

To view the CY 2021 Physician Fee Schedule and Quality Payment Program proposed rule, see:
https://s3.amazonaws.com/public-inspection.federalregister.gov/2020-17127.pdf

SCMR Social Justice Statement

The Society for Cardiovascular Magnetic Resonance (SCMR) recognizes that the shocking events in the United States and subsequent global #BlackLivesMatter protests, have a profound impact in our communities. We would like to re-affirm that the SCMR stands against racism, prejudice and discrimination in all its forms. We reject hatred and violence and we are committed to supporting those who are victimized, alienated or marginalized.

Our Society embraces and encourages diversity in age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our membership unique. These values are enshrined in the “SCMR Equality, Diversity and Inclusion Statement” published on the SCMR website on the 28^th of February 2020 (https://scmr.org/news/491081/SCMR-Equality-Diversity-and-Inclusion-Statement.htm).

Currently, we are facing two global pandemics of systemic racism in modern society and the coronavirus infection, which has exposed inequities in our healthcare systems. As an international organization, we are confronting these global challenges by actively promoting diversity, inclusion and integration as well as by addressing health disparities in cardiovascular disease by making cardiovascular magnetic resonance available to underserved communities. We are a global community of physicians, scientists, technologists, and educators and our mission is to provide outstanding care for everyone, make scientific discovery available for all humanity and teach fairness and justice to our trainees.

Learn More

Shafkat Anwar MD^a,d, Michael J. Bunker MS^d, Eric W. Lam PhD^b,e, Alexis Dang MD<sup>c,d

a</sup>Department of Pediatrics. ^bDepartment of Biochemistry and Biophysics. ^cDepartment of Orthopaedic Surgery.  ^dCenter for Advanced 3D+ Technologies (CA3D+). 
^eKAVLI-PBBR Fabrication and Design Center (FAD).  
University of California San Francisco School of Medicine, San Francisco, CA

The coronavirus disease 2019 (COVID-19) pandemic is taking a tremendous toll on the global population and healthcare systems.  As of April 26 2020, the World Health Organization (WHO) reports 2,810,325 cases globally, including 193,8251.   In the United States of America (USA), there have been 859,766 cases with 50,439 deaths2 as of April 24, 2020.

The COVID-19 pandemic has exposed several deficiencies within healthcare systems.  Key problems hampering the COVID-19 response have been limited testing supplies and personal protective equipment (PPE) for healthcare workers (HCW), and ventilators for patients.  As frontline HCWs and researchers work under these challenging conditions, innovators have rapidly pivoted to 3D printing (3DP) technologies as a response.  3DP enables flexible design, rapid prototyping and manufacturing – critical factors to meet sudden, unpredicted surges in demand.

The following is a summary of the landscape of 3D printing in healthcare in response to the COVID-19 crisis.  This is a rapidly evolving field with innovations emerging daily, and as such any summary may approach obsolesce in short order.  Thus, our goal is to provide an overview of pertinent applications and regulatory information to-date, as well as the primary source resources that will aid the reader stay up-to-date on this topic.  




1. Food and Drug Administration (FDA) and 3D printing for COVID-19 

The FDA’s answers to frequently asked questions (FAQ) for entities who 3D print devices, accessories, components, and/or parts during the COVID-19 emergency:  
https://www.fda.gov/medical-devices/3d-printing-medical-devices/faqs-3d-printing-medical-devices-accessories-components-and-parts-during-covid-19-pandemic

FDA Enforcement Policy for Face Masks and Respirators for CODIV-19: 
https://www.fda.gov/media/136449/download

While it may be technically possible to produce some 3D printed PPE, it is vitally important to recognize the limitations of 3D-printed solutions.  For example, for surgical masks and respirators the FDA notes: 

“3D-printed PPE may provide a physical barrier, but 3D-printed PPE are unlikely to provide the same fluid barrier and air filtration protection as FDA-cleared surgical masks and N95 respirators. The CDC has recommendations for how to optimize the supply of face masks.” 

To harness the capacity of the capacity of the 3D printing industry, the FDA has entered a collaboration with Department of Veterans Affairs (VA) Innovation Ecosystem and the National Institutes of Health (NIH) 3D Print Exchange and the additive manufacturing (AM) organization America Makes.  The goal of this collaboration is to connect stakeholders, facilitate information-sharing and process Emergency Use Authorization (EUA) Applications to make available medical devices in response to COVID-19 crisis. 

https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/fda-efforts-connect-manufacturers-and-health-care-entities-fda-department-veterans-affairs-national

       i.        NIH 3D print exchange

A curated collection 3D printing designs in coordination with the FDA, VA, and America Makes to connect healthcare providers and 3D printing organizations:

https://3dprint.nih.gov/collections/covid-19-response

       ii.        US Dept of Veterans Affairs (VA) Innovation Ecosystem

Dep’t of VA 3D printing, design sharing, feedback and testing resource:

https://myvapm.force.com/3DPrintingNew/s/

     iii. America Makes

America Makes is the Department of Defense’s Manufacturing Innovation Institute (DoD MII) for additive manufacturing.  America Makes is comprised of member organizations across government, academic and private sectors to accelerate additive manufacturing.  

 3.  3D Printed solutions in Response to the COVID-19 Crisis

The following is a sample of solutions to date.  We are highlighting 5 solutions for the healthcare setting, realizing there are many more in various stages of development. 

We have prioritized solutions that have received emergency use authorization (EUA) from the FDA, or are FDA-exempted.  This is not a comprehensive list, and the reader is encouraged to reference the NIH 3D Print Exchange website above for more information.  Inclusion of these solutions in this publication does not constitute an endorsement of these products.  The reader is advised to independently ensure the quality, safety, and efficacy of these designs.

       i.        3D Printed Face Shield

The design for the UCSF 3D Shield was inspired by the Prusa RC2 model, with modifications. The UCSF face shield uses an 8.5”x11” transparency sheet which is readily available and mounted after a simple 3-hole punch.  The user puts on the face shield using interlinked rubber bands, which are replaceable as needed and easy to source.  They are printed on FDM printers, are low cost, and at a capacity of 300+ shields a day by a team of volunteers at the UCSF library. 

https://www.library.ucsf.edu/news/ucsf-3d-printed-face-shield-project/

Figure 1: UCSF Face Shields project.  Left panels: 18 3D printers producing face shields.  Right panel: Dr. Alexis Dang wears an assembled face shield over an N-95 respirator

       ii.        3D Printed Surgical Face Mask

According to the designers, “The Stopgap Face Mask (SFM) was created as an emergency action in effort to protect people by providing backup PPE options if the standard PPE has become unavailable.”  The mask uses 3D-printed components that houses filter material from a conventional face mask. 

https://3dprint.nih.gov/discover/3dpx-013429

As one conventional face mask can it up to four SFMs the potential value-add of the device is to augment the supply of standard surgical face masks if times of shortage.  It should be noted that this device is NOT an N95 respirator.  The device is printed on a Multi-Jet Fusion (MJF) or Selective Laser Sintering (SLS) printer out of powder-bed nylon, and has received EUA from the FDA.   

      iii.        Nasal Swabs

Widespread COVID-19 testing is one of the critical factors to successfully counter this pandemic.  The Centers for Disease Control (CDC) recommends collecting and testing an upper respiratory specimen from a nasopharyngeal (NP) swab-based sample³.  However, a shortage of specialized NP swabs is one of the factors hampering widespread testing.  3D printed NP swabs have been developed to rapidly augment the existing supply.  A consortium of collaborators from industry and academia have identified several 3D printed swabs for use in COVID-19 testing.  The consortium includes the academic institutions Beth Israel Deaconess Medical Center, Stanford University; the University of South Florida; and the University of Washington, and industry partners Carbon and Resolution Medical, EnvisionTEC, FormLabs, HP, OPT Industries and Origin.

https://www.bidmc.org/about-bidmc/news/2020/04/3d-printed-swabs

A clinical trial by this consortium has identified four novel prototypes of 3D-printed swabs that can be used for COVID-19 testing.  A preprint of the manuscript is available

here: https://www.medrxiv.org/content/10.1101/2020.04.14.20065094v1

Examples of these NP swabs are available here:

https://www.carbon3d.com/covid19/

https://formlabs.com/covid-19-response/covid-test-swabs/

https://www.origin.io/npswab/

        iv.        3D Printed ventilator expansion device

The COVID-19 crisis has been marked by a shortage in the supply of ventilators to deliver critical support.  3D printing has been applied to create adapters that increase the capacity of ventilators to support more than one patient.  One example is from Prisma Health, which has received emergency use authorization from the FDA for VESper™_.   This device that allows one ventilator to support up to two patients during times of acute ventilator shortages.  Details here: https://www.prismahealth.org/VESper/

       v.        3D printed Door Handles

The SARS-CoV-2 virus, responsible for COVID-19, can remain infectious on solid surfaces for up to 72 hours⁴.  To mitigate viral transmission via the contact route, “hands-free” handles have been rapidly prototyped and 3D printed.  These handles allow users to open doors without using a hand to grasp the door handle.  These are technically not medical devices and thus do not fall within the purview of FDA regulation.  However, users should check with their institution’s internal groups prior to installing.  These “devices” may require clearance from the safety and accessibility standpoints, which include stress testing fire-safety clearance, and compliance with Americans with Disabilities Act (ADA) standards.  A few examples are shown here:

UCSF 3D Printed Door Opener

https://ucsf.box.com/s/d2uos6twtl46styjogyjstcsx6zviggb

Materliase 3D Printed Door Opener

https://www.materialise.com/en/hands-free-door-opener

4.  Conclusions

The COVID-19 pandemic has had devastating consequences on human health and well-being, while severely straining the health care industry and traditional supply chains.  3D printing and rapid prototyping technologies have allowed innovators, healthcare workers and researchers the ability to quickly create solutions to tackle some of these problems.  While 3D printing technology is now ubiquitous and more accessible than ever before, most 3D printed solutions currently exist outside the bounds of traditional FDA and other regulatory-body testing.  Therefore, caution must be exercised when implementing these new solutions in the clinical environment.  At the same time the COVID-19 crisis has united academic, healthcare and industry partners to collaborate on an unprecedented scale.  This shall likely have a lasting positive effect on healthcare in the era post- COVID-19. 

References

Please reference the links above, and:

1.    World Health Organization COVID-19.   https://covid19.who.int/

2.    Centers for Disease Control and Prevention. Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for Coronavirus Disease 2019 (COVID-19)  https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html

3.    Aerosol and Surface Stability of SARS-CoV-2 as Compared with
SARS-CoV-1

 https://www.nejm.org/doi/full/10.1056/NEJMc2004973#readcube-epdf

In the light of the COVID-19 pandemic, CMR departments are closing to all but emergency scans, with clinicians re-deployed to ward and critical care cover. The need for high quality research is however greater than ever, and barriers are being broken down to deliver this.

At Barts Heart Centre and UCL in London the team (led by Professor James Moon) are leading an international study in collaboration with Professor Ntobeko Ntusi at University of Cape Town to understand the immunological and genetic factors determining COVID-19 disease severity. Data and samples are collected weekly from healthcare workers over the next 16 weeks, the majority of whom will be exposed and of whom a proportion will develop severe disease. The over 50,000 samples that this will generate will be disseminated worldwide to the best scientists for further analysis to enable novel insights into the disease. 

View the updated training guideline on JCMR >>

Our people are the most valuable asset we have. The collective sum of their individual differences, life experiences, knowledge, innovation, self-expression, and talent represents a significant part of our culture and reputation. Our Society embraces and encourages diversity such as in age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our membership unique.

SCMR’s commitment to diversity is applicable—but not limited—to our practices and policies on leadership and volunteer selection, professional development and training, and ongoing work to improve cardiovascular health by advancing the field of CMR.

All members, volunteers, staff, and industry partners have a responsibility to treat others with dignity and respect at all times. They are expected to exhibit conduct that reflects inclusion at SCMR Headquarters, for business communications, and at all SCMR supported events.

This document is an update to the 2013 publication of the Society for Cardiovascular Magnetic Resonance (SCMR) Board of Trustees Task Force on Standardized Protocols. Concurrent with this publication, 3 additional task forces will publish documents that should be referred to in conjunction with the present document. The first is a document on the Clinical Indications for CMR, an update of the 2004 document. The second task force will be updating the document on Reporting published by that SCMR Task Force in 2010. The 3rd task force will be updating the 2013 document on Post-Processing. All protocols relative to congenital heart disease are covered in a separate document. The section on general principles and techniques has been expanded as more of the techniques common to CMR have been standardized. A section on imaging in patients with devices has been added as this is increasingly seen in day-to-day clinical practice. The authors hope that this document continues to standardize and simplify the patient-based approach to clinical CMR. It will be updated at regular intervals as the field of CMR advances.

View the updated training guideline on JCMR >>

SCMR Gold Medal Award

The Board of Trustees have named Peter Kellman and Jeanette Schulz-Menger as the 2020 SCMR Gold Medal Award recipients. Read more.

Best Image Award

The Great Mitral Wave - Gilles Jean Eugene Soulat Northwestern University

ABSTRACT AWARDS

Early Career Award - Clinical Science 

• Independent and relative value of late gadolinium enhancement in predicting compromising ventricular arrhythmia or mortality in adults with repaired tetralogy of Fallot - Sarah Ghonim, et al.

Early Career Award - Basic Science and Technical Developments

• Assessment of ischaemic burden in multi-vessel coronary artery disease using CMR pixelwise quantitative perfusion mapping - Tushar Kotecha, et al.

Best Moderated e-Poster

•  Diagnostic accuracy of high resolution stress myocardial perfusion imaging with whole heart coverage at 3T - Austin Robinson, et al.

Best Technologist Abstract

• Cardiac Mass or Aneurysmal Saphenous Vein Graft? - Bao Ru Leong

Best Web Case of the Week

• Early Diagnosis of a Systemic Disease by CMR Prevents Complications - Arun Dahiya

JCMR BEST MANUSCRIPT AWARDS

13th Gerald M. Pohost Award

• Quantification of lung water in heart failure using cardiovascular magnetic resonance imaging - Richard B. Thompson, et al.

13th Gerald M. Pohost Award Runner-Up

• The relative contributions of myocardial perfusion, blood volume, and extracellular volume to native T1 and T2 at rest and during adenosine stress in normal physiology - Jannike Nickander, et al.

3rd Dudley J. Pennell Award

• A Medical Device—grade T1 and ECV phantom; G. Captur, et. al.

3rd Dudley J. Pennell Award Runner-Up

• Top 100 cited articles in cardiovascular magnetic resonance: a bibliometric analysis - Khan et. al.

As 2020 has just begun we wanted to share some highlights and celebrate achievements that occurred in the past year. 

The 2019 Annual Scientific Sessions in Seattle were a great success with over 1,400 attendees, a record number of abstracts, and many innovative sessions. Program Chair Allison Hays did remarkable work and we all left Seattle with a more knowledge, new friends, and fond memories. 

We deeply appreciate the work of all the SCMR volunteers to enhance the Society, offer value for our members, and promote the role of CMR in cardiovascular health globally. Just a few of the many highlights follow. The Education Committee (chair: Patricia Bandettini) launched the Physics Webinars which are a great success. The Advocacy Committee (chair: Sebastian Kelle) continues to work relentlessly on cost-effectiveness of the CMR and the international CMR cost-calculator. The new SCMR Registry (chair: Lon Simonetti) reached a milestone by enrolling its first centers. Those interested in also joining should attend the SCMR Registry hands-on tutorial session in at our upcoming Annual Scientific Sessions in Orlando. The first study generated from the SCMR Registry was the SPINS trial recently published in JACC. 

Our SCMR level 1 courses in Columbus, Ohio, and New York City were a great success and taught many physicians about the power of CMR. 

SCMR leadership has been aggressively pursuing advocacy efforts around the globe throughout the year. This included a successful campaign to have our US physician members join the American Medical Association (AMA) which led to an SCMR seat in the AMA Specialty and Service Society Caucus (represented by Ted Martin, SCMR US advocacy chair). SCMR has now joined the American College of Cardiology and other specialty societies as they debate and inform health care policies that will shape the future of medicine. We would also like to thank our industry partners on the Corporate Advisory Board for their support of several major new advocacy initiatives. The Heart MRI awareness campaign (www.heartMRI.org) has led to a significant increase in our social media and TV presence, along with coverage in national and local press. Our social media presence continues to also grow both on Twitter (@scmr.org), Linkedin and Facebook. Follow and join for the latest SCMR opportunities and CMR news. If you want to learn how to use social media and open an account, come to our Social Media Clinic at our upcoming Annual Scientific Sessions in Orlando. Do you want another way to show your support? Visit our online shop, SCMR K-Space, where you can order your favorite SCMR swag like T-shirts, mugs, hats, mouse pads, and many others.  

Following our recent election, SCMR is delighted to welcome its new Board of Trustee members (2020-2022): Marianna Fontana (non-US Cardiologist), Jennifer Bryant (Technologist), Claudia Prieto (non-US Scientist), and Paul Finn (US Radiologist). Subha Raman was elected as Vice-President, and Karen Ordovas as the Vice Secretary Treasurer. We would like to warmly thank the outgoing board members for their commitment and dedication to SCMR over the last few years: Alistair Young (non-US Scientist), Lilia Sierra Galan (non-US Cardiologist), Karen Ordovas (US Radiologist), Stephen Darty (Technologist), and Matthias Stuber (Past-President). 

The past year saw several staff changes at SCMR. Lon Simonetti stepped down as CEO in March and, after a competitive search process, Chiara Bucciarelli-Ducci was selected as the new CEO. Shaunna Lee (Program Manager) departed from SCMR in October and has been replaced by Lauren Small. Pete Pomilio, our Chief Operation Officer since 2016, is currently transitioning out of his position following the Scientific Sessions. We thank Pete for his enormous contributions to SCMR and credit him with much of SCMR's fantastic financial and membership growth. 

We now look forward to seeing you all at the 2020 SCMR Annual Scientific Sessions in Orlando, Florida, on February 12-15. Lars Grosse-Wortmann (Program Chair) and his Program Committee have created a phenomenal meeting around the theme of Precision Cardiology. Expect world-class speakers, seamless links between clinical CMR and cutting-edge imaging developments, and outreach sessions that position CMR in the cardiology context. The program reflects our vibrant community, offering innovative session formats, hands-on learning, and more networking opportunities than ever before. There will be plenty of chances for you to get involved, including post processing workshops, social media 1x1, second opinion clinics, early career sessions, and much more. Christopher Francois (Abstract Chair) has led the effort to showcase the latest advances in CMR to keep you current. Remember to sign-up for our 1st SCMR 5K Fun Run and reserve Childcare Services (offered for the 1st time). 

We expect 2020 to be filled with more SCMR initiatives and accomplishments so stay tuned. Best wishes for a rewarding and healthy new year. 

Andrew Powell
SCMR President 

Author: Ibrahim M. Saeed, MD, FACC, FSCMR

As a physician who has seen a presentation of nephrogenic systemic fibrosis (NSF) in clinic, I am especially sensitive to the risks associated with gadolinium-based contrast agents (GBCAs) in the setting of kidney disease.  And yet as clinicians, we are all too familiar with the need to balance that with the definitive diagnostic testing that MRI provides.  How do we educate our patients and our referring colleagues given the paucity of recent data with newer Group II agents and the fear of a future life-threatening event?

A recent meta-analysis by Woolen and colleagues in the December 9, 2019 issue of JAMA Internal Medicine attempts to provide us with that data.  After pooling data from 4931 patients from sixteen studies, they concluded that the risk of developing NSF is likely less than 0.07% (upper bound 95% CI risk estimate).  The agents specifically used were:

Elected were:

Vice President

 Subha Raman, MD, FSCMR

 Vice-Secretary- Treasurer

 Karen Ordovas, MD, MAS, FSCMR

 Board of Trustees - Non-US Cardiologist

Marianna Fontana, MD, PhD
 

Board of Trustees - US Radiologist

J. Paul Finn, MD

 Board of Trustees - Technologist

Jennifer Bryant, PhD

Board of Trustees - Non-US Scientist

Claudia Prieto, PhD

Board of Trustees - Early Career

Purvi Parwani, MD

Congratulations to all and welcome to the SCMR Board of Trustees.

Improving the diagnosis of cardiac diseases in Developing Countries with Rapid Cardiac Magnetic Resonance –  “Rapid CMR”, is an international research collaboration project which has grown due to the contribution of various institutions and professionals (cardiologists, radiologists, technologists, physicists) with the support of the Society for Cardiovascular Magnetic Resonance (SCMR). The main aim of this project is to implement a rapid CMR scan for low-middle income countries, and to deliver it, embedding it within clinical care, training and mentoring so it is a self-sustaining and essential service. 

For this specific visit, an education and training program was delivered over 2 days and half to 164 participants (cardiologists, radiologist and technologists) from the whole country (delegates from La Havana, Matanzas, Villaclara, Camaguey and Santiago de Cuba) and international (delegates from Bolivia, Ecuador, Guyana, Honduras, Timor Leste and Dominican Republic) between the 01st and 03rd of November. The program consisted of theory sessions covering the syllabus for Level 1 SCMR Certification, hands-on training with the support of Circle Cardiovascular Imaging and the use of  7 reporting workstations and the main plenary session with the discussion of clinical cases with experts. SCMR provided a free level I SCMR certificate as well as a 1-year free membership to all the participants. 

Dr Yuchi Han says “As SCMR outreach committee, we want to extend the practice and use of CMR to more nations, with specific attention to low-middle income countries. This specific initiative is showing that cardiac MRI can be undertaken rapidly, safely and reliably. We are excited about the prospects for this technology in Cuba, to help a larger proportion of people at risk to benefit from it and to widen the message of CMR to more health professionals in the country by providing a high-level training and education opportunity. 

Our sincere acknowledgments to the local sponsors of the conference: The National Hotel in Cuba, Club Habana and Solintel. You can find more information about the project on the following link: www.rapidcmr.com and e-mail: info@rapidcmr.com 

The OPPS rule governs technical component (TC) reimbursement for medical services provided in the hospital outpatient setting. Technical component reimbursement is intended to reflect the non-physician costs of the procedure. Under the OPPS, CMS assigns each individual medical service to an Ambulatory Payment Classification (APC) group, and all services included within a designated APC group are reimbursed at the same rate. 

By law, all services included within a single APC group are required to be similar clinically and in resource use.  Unfortunately, over the last several years CMS has loosened its interpretation of clinical homogeneity and has grouped clinically dissimilar services together in APCs.  This has resulted in a marked and significant decline in technical component reimbursement for many imaging services, including CMR codes.

SCMR submitted comments to CMS to express concerns about APC placement and to set forth a justification for moving CMR codes to other APCs that contain services that are more clinically similar.  CMS rejected the arguments.  SCMR plans to follow up with CMS early in 2020 to further discuss how CMS views the concept of clinical homogeneity.

Once again, we are faced with reductions in OPPS reimbursement for most codes except CPT 75557.  To improve reimbursement under the OPPS, facilities must accurately capture the cost of each and every component of providing a CMR service when submitting a Medicare claim. Hospital charge masters should be updated to appropriately reflect these costs.  Without adequate claims data that reflects the true cost of providing CMR services, reimbursement may continue to decline.

In the text of the final 2020 hospital outpatient rule, CMS noted in part:

            ‘with regard to the issue of different hospital cost reporting methods, we are unable to determine whether hospitals are misreporting the procedure. It is generally not our policy to judge the accuracy of hospital charging and coding for purposes of ratesetting.  We rely on hospitals to accurately report the use of HCPCS codes in accordance with their code descriptors and CPT and CMS instructions, and to appropriately report services on claims and charges and costs for the services on their Medicare hospital cost report.  Also, we do not specify the methodologies that hospitals use to set charges for this or any other service.  Furthermore, we state in Chapter 4 of the Medicare Claims Processing Manual that “it is extremely important that hospitals report all HCPCS codes consistent with their descriptors; CPT and/or CMS instructions and correct coding principles, and all charges for all services they furnish, whether payment for the services is made separately paid or is packaged" to enable CMS to establish future ratesetting for OPPS services.’

SCMR will continue to examine CMS cost center policies and how hospital cost to charge ratios affect CMR reimbursement.  The SCMR has also taken active steps by hiring a consultant to analyze current hospital charging practices so that a road map can be created to combat the low reimbursement. We recognize that continued reductions are unsustainable and jeopardize the availability of cardiac MR services.

Below is a chart with final rule payment amounts for the CMR codes. Note that both the Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System payments are reflected.  The MPFS contains the professional component (PC) payment (physician payment). It also contains the TC payment for imaging services provided in the physician office setting. Payment for the TC provided in the office setting is capped at the lesser payment amount of that provided under MPFS or OPPS.

SCMR will continue to review both rules for provisions of interest to the imaging community. You may view the proposed rules and CMS Fact Sheets at:

• MPFS Rule Text
  
• Fact Sheet MPFS
• OPPS Rule Text
  
• OPPS Fact Sheet
  

This accomplishment is a wonderful example of our U.S. physician members’ commitment to SCMR. We needed to have 10 percent of our SCMR U.S. physician members also be members of AMA, and these colleagues rallied to the cause and joined the AMA. Our campaign’s success was unprecedented and achieved its goal in just one month. SCMR is extremely grateful for this.

We look forward with pride to our full participation in SSS activities. SCMR is fortunate that Edward Martin, MD, FSCMR, Chair of our U.S. Working Group, has agreed to represent SCMR in the SSS.

As a member of the SSS, SCMR will advocate for the cardiovascular magnetic resonance community. SCMR will also participate in the cardiovascular diseases section council at AMA, joining our colleagues from ACC and other cardiovascular specialty societies as they debate and inform health care policies that will shape the future of medicine. Please stay tuned for important updates from the November 2019 meeting! More advocacy projects are well underway throughout the world and we look forward to sharing them with you in the near future.

Sincerely yours,

Andrew Powell, MD, FSCMR

SCMR President

To these points, the Society has developed a new position statement addressing the clinical practice of CMR and the different specialties represented within SCMR. This statement was approved by the Board of Trustees on July 27th, 2019.

View full statement >>

Thank you to Raymond Kwong, lead author and principle investigator, Orlando P. Simonetti, the former SCMR CEO, the participating sites, and Siemens Healthineers and Bayer for supporting the trial.

The OPPS rule governs technical component reimbursement for medical services provided in the hospital outpatient setting. Technical component reimbursement is intended to reflect the non-physician costs of the procedure. Under the OPPS, CMS assigns each individual medical service (i.e., each individual HCPCS code) to an Ambulatory Payment Classification (APC) group, and all services included within a designated APC group are reimbursed at the same rate.  By law, all services included within a single APC group are required to be similar clinically and in resource use.  Unfortunately, over the last several years CMS has loosened its interpretation of clinical homogeneity and has grouped clinically dissimilar services together in APCs.  This has resulted in a marked and significant decline in technical component reimbursement for many imaging services, including CMR codes.

To improve reimbursement under the OPPS, facilities must accurately capture the cost of each and every component of providing a CMR service when submitting a Medicare claim. Hospital charge masters should be updated to appropriately reflect these costs.  Without adequate claims data that reflects the true cost of providing CMR services, reimbursement will continue to decline. SCMR will continue to engage CMS about appropriate APC assignment for CMR services and explore data modeling to identify more appropriate placement for CMR codes.

Below is an imaging chart with associated reimbursement impacts for the CMR codes, under both the OPPS and MPFS proposed rules.  SCMR will continue its analysis and provide comments to CMS by the September 27, 2019 deadline.

A CMS Fact Sheet on the overall provisions of the proposed MPFS rule is available at: 

https://www.cms.gov/newsroom/fact-sheets/proposed-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-2

A CMS Fact Sheet on the overall provisions of the proposed OPPS rule is available at:

https://www.cms.gov/newsroom/fact-sheets/cy-2020-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center

This approval was based on the GadaCAD trials; two prospective, multinational, non-randomized, blinded-read Phase 3 studies of almost 1,000 adults with suspected or known CAD based on signs and symptoms. Nearly 800 of those patients were evaluated for efficacy. The GadaCAD trail builds on the existing scientific data that validates cardiac MRI, which includes the recent publishing of the MR-INFORM study

This milestone further validates the use of cardiac MRI as a key diagnostic tool and gives the 16.5 million patients with Coronary Artery Disease (CAD) an additional non-invasive diagnostic tool. 

65 healthcare professionals gathered at The Ohio State University in Columbus, Ohio on July 13^th and 14^th for the SCMR Foundations of CMR Level I Workshop. The 2-day workshop was organized by Co-Chairs Dr. Subha Raman and Dr. Orlando Simonetti, both from The Ohio State University. The workshop began with opening remarks by Dr. Raman and Dr. Simonetti, providing an overview of the workshop.

The theme of the morning session was “Basics of CMR” and emphasized MR physics, safety, and assessment of the LV and RV function, basic CMR pulse sequences and general considerations in patient selection for CMR. The morning closed with an overview of the two software platforms utilized during the case sessions (provided by Arterys, Inc. and NeoSoft, LLC). Attendees then split into two groups and alternated between hands-on sessions focused on “Assessment of Cardiac Function and Morphology.”

Following the morning sessions was a lunchtime presentation by Amy Tipton highlighting the past, present and future of CMR. (Sponsored by Circle Cardiovascular Imaging, Inc.) The afternoon sessions focused on Ischemic and Nonischemic Heart Disease along with CMR and arrhythmias; During the final session of the day, attendees worked on cases focusing on cardiomyopathies. (provided by Arterys and NeoSoft) Day one concluded with all participants, faculty, and sponsors networking during the evening reception.

Day two began with several expert sessions covering CMR In Valvular Disease, Congenital Heart Disease, and Artifacts. Attendees then split up for case sessions (provided by Arterys,Inc. and NeoSoft, LLC) covering valvular and congenital heart disease. The final set of didactic sessions covered masses, pericardial disease, and vascular disease followed by sessions focusing on CMR in practice in a city with less than 50,000 people, a large metropolitan city and a VA hospital. The sessions concluded with a roundtable discussion focused on keeping your practice current with changing technology. Co-chairs Dr. Subha Raman and Dr. Orlando Simonetti wrapped up the workshop with key take-a-ways and review questions.  

The Ohio State University

• Daniel Addison, MD
• Rizwan Ahmad, PhD
• Salman Bhatti, MD
• Saurabh Rajpal, MD
• Subha Raman, MD, FSCMR
• Orlando Simonetti, PhD, FSCMR
• Matthew Tong, DO
• Juliet Varghese, PhD
• Karolina Zareba, MD

OhioHealth

• Sharon Roble, MD
• Jay Mukherjee, MD

Carnegie Hill Radiology

• Steven Wolff, MD, PhD

Cleveland Clinic

•  Scott Flamm, MD
• Deborah Kwon, MD

Fairfax Radiological Consultants

• Melany Atkins, MD

Louis A. Johnson VA Medical Center

• George Shehl, MD

Nationwide Children's Hospital

• Rajesh Krishnamurthy, MD

Northeast Ohio Medical University

• J. Ronald Mikolich, MD, FSCMR

The Christ Hospital

•   Wojciech Mazur, MD

University Hospitals of Cleveland

• Sanjay Rajagopalan, MD

University of Pittsburgh

• Erik Schelbert, MD

Sponsors

• Arterys, Inc.
• Bayer
• Circle Cardiovascular Imaging
• Guerbet
  
• Medis Medical Imaging
• NeoSoft, LLC

According to the 2018 InCites Journal Citation Reports, JCMR placed 28th out of 136 journals in the Cardiac & Cardiovascular systems category and 16th out of 129 journals in the Radiology, Nuclear medicine & Medical imaging category. The total number of citations of JCMR articles was up from 4,918 citations in 2017 to 5,113 in 2018.

The outstanding Impact Factor reflects the high scientific and clinical value of the papers published in JCMR. Congratulations Editor Warren Manning and to all of those who helped contribute to the success of the journal!

The MR-INFORM trial looked at whether magnetic resonance imaging (MRI) could be used to guide treatment decisions for angina patients, rather than performing a more invasive procedure.

Angina is chest pain caused by reduced blood flow to the heart muscles. The condition affects two million people in the UK and is a warning sign that you could be at risk of a heart attack or stroke. Treatments include drugs to lessen the pain and changes to a healthier lifestyle.

Currently patients diagnosed with the condition are usually sent for an invasive angiography, a procedure which involves taking X-rays of the patient's arteries, and involves multiple hospital visits, including an overnight stay. If the condition is severe, patients have a procedure to improve blood flow to the heart called revascularisation.

The MR-INFORM trial looked at 918 patients with angina and risk factors for coronary heart disease, who were divided into two groups. One received the standard invasive angiography. The other had the 40 minute MRI perfusion scan of the heart, to decide whether to send the patient on for invasive angiography.

The two groups had similar outcomes for patients' health with under 4% of patients in both groups having cardiac events (such as heart attacks), in the following year. However, the group whose treatment was dictated by their MRI scan had significantly fewer procedures, with only 40% of this group going on to have invasive angiography. Only 36% of the MRI group went on to have revascularisation, compared to 45% in the other group.

Professor Eike Nagel, a consultant cardiologist and chair in Clinical Cardiovascular Imaging at King's College London, led the research. He said: "Personalising patients' treatment for angina will mean that we can target the more invasive treatments only to those patients that really need them.

"We have shown that MRI imaging, which is less invasive than current diagnostic tests, could mean that patients' initial visits to hospital are quicker and more patient friendly, and that they are less likely to have further procedures. But crucially the outcomes for patients of taking this approach were similar, so there is no negative impact of directing treatment in this way only to those we're sure need it.

"We are really grateful to patients across Europe who participated in the study."

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The research was funded by the NIHR Guy's and St Thomas' Biomedical Research Centre, and the German Center for Cardiovascular Research (DZHK), with supplemental corporate support from Bayer (Leverkusen, Germany) as an unrestricted grant payable to King's College London.

Contact: Anna Perman, Communications Manager, NIHR Biomedical Research Centre at Guy's and St Thomas' and King's College London tel: 07717 817 714 or e-mail: anna.perman@gstt.nhs.uk