Washington, DC -- Ultrasound is a safe and important tool in women's prenatal and gynecologic care, and Congress should not pass legislation that could delay women's access to diagnosis and treatment for basic health care needs, according to Douglas W. Laube, MD, MEd, president of The American College of Obstetricians and Gynecologists (ACOG), who testified today before the House Energy and Commerce Health Subcommittee.
The House Energy and Commerce Health Subcommittee is reviewing the growth and costs of imaging services in Medicare and whether there should be new restrictions on their use. ACOG believes the safety, necessity and cost-saving value of ultrasounds in the ob-gyn office should exempt these procedures from new restrictions. This includes any requirements that women must visit other physicians to get the services they can quickly and safely get from their ob-gyn, who is well trained in the use of ultrasound.
Restricting in-office imaging would result in substantial inconvenience and costs for patients, who would have to schedule a new appointment, with a different facility and a different physician, when the necessary testing could be performed on the spot by the patient's own physician. Continuity of care would be interrupted, and the treating physician would lose valuable time in detecting and treating a condition.
Dr. Laube stressed the importance of quick access to ultrasound. "Many ultrasound exams need to be performed urgently, such as when a woman experiences unexplained bleeding, pelvic pain, or discovery of a mass," noted Dr. Laube. "Some emergencies, like ectopic pregnancies [pregnancy outside the uterus] and complications during active labor, can be life threatening and require immediate ultrasonography," he added.
"In obstetrics, ultrasound is useful in helping to date a pregnancy, in estimating the amount of amniotic fluid, and in detecting some birth defects. It also helps guide the needle placement during amniocentesis screening to detect fetal problems, and thus helps reduce the risk of maternal or fetal injury," said Dr. Laube.
"In gynecology, ultrasound can help identify the cause of unexplained bleeding in post-menopausal women or visualize a mass felt during a manual exam," Dr. Laube explained. "Its noninvasive nature and real-time precision make ultrasound an essential tool for early diagnosis of disease."
Dr. Laube distinguished ultrasound from other, more complicated imaging services – such as CT, MRI or PET scans – where further regulation is being examined. Among the points Dr. Laube made today:
- Ultrasound is safe. Unlike other imaging, ultrasound does not involve ionizing radiation. It does not use contrast media and does not require sedation.
- Ob-gyns are well-trained in ultrasound. Diagnostic ultrasonography is part of ob-gyn residency training and part of the certifying examinations of the American Board of Obstetrics and Gynecology.
- Use of ob-gyn ultrasound in clinical care increases quality and saves costs. Ultrasound speeds time to diagnosis, particularly in critical situations. It improves the safety and effectiveness of procedures, improves diagnostic accuracy, and allows greater use of minimally invasive treatment. This is also true for ultrasound guidance procedures.
- Growth in ultrasound use is slower than growth in other health care services. From 1999 to 2003, ultrasound imaging services grew more slowly than all Medicare Part B services (i.e., 7.2% vs. 7.8%) when looking across physician and outpatient settings. For some categories of ultrasound services, such as the ultrasound codes billed by ob-gyns for diagnosis of gynecologic conditions, the growth has been less than 4% a year.
Today's hearing focused on imaging in Medicare only. However, decisions about Medicare policy by the House Energy and Commerce Health Subcommittee are often adopted widely by private payors and by TRICARE, the health care system for 9 million military families.