The field of cardiovascular imaging is shifting, and it's happening faster than many service line leaders realize. Most notably, computed tomography angiography (CTA), a simple imaging procedure, is increasingly replacing diagnostic catheterization, an invasive procedure that requires inserting thin tubing into a patient's heart, as the first-line diagnostic tool for coronary artery disease (CAD). With advances in imaging technology, a push toward noninvasive diagnostics, and recent reimbursement changes, the question is no longer whether CTA will become the standard for many diagnostic evaluations, but when.
It's unclear when payers will start actively favoring CTA over diagnostic caths in their reimbursement and coverage policies. However, early signs suggest that CTA is steadily advancing toward becoming the clinical standard. For cardiovascular service line administrators and health system executives, this means navigating declining cath lab volume, shifting physician roles, and new financial realities. Health systems that proactively prepare for this transition will be well positioned for success, while those that don't may find themselves playing catch-up in a rapidly evolving landscape.
The Growing Role of CTA in Cardiovascular Diagnostics
The role of invasive diagnostic cath in evaluating coronary artery disease is being redefined. Advancements in imaging, particularly in noninvasive, high-resolution scanning, are enabling clinicians to diagnose CAD with greater speed, safety, and precision than ever before. The American College of Cardiology recommends a CTA-first approach due to the procedure's clinical benefits and potential for long-term cost savings, as detailed below.
- Reduced Patient Risk: CTA is a noninvasive imaging procedure; as such, procedural risks are almost nonexistent.
- Timeliness: A CTA scan can be completed in minutes versus the much longer process of catheter insertion and recovery.
- Improved Accuracy: Advances in imaging technology, including AI-enhanced interpretation, are improving CTA's diagnostic power. Evidence suggests that CTA may enable more accurate and earlier detection of CAD, potentially increasing referrals for peripheral cardiovascular interventions (PCI) and decreasing the demand for downstream surgical procedures.
A 2023 meta-analysis found that a CTA-first approach prevented the need for invasive angiography in 77% of patients who would have otherwise undergone a diagnostic cath. Similarly, in regions where CTA adoption is more widespread, cath lab volume has declined without any negative impact on patient outcomes. These stats reinforce the need for health systems to rethink how and when invasive diagnostics are truly necessary, as for many diagnostic evaluations, CTA provides a safer, faster, and more cost-effective alternative.
Financial Implications
As CTA begins to replace diagnostic cath as the first-line evaluation tool for CAD, health systems must reassess the financial structures and sustainability of their cardiovascular service lines. The implications extend beyond reimbursement—they touch nearly every facet of the care delivery model, including provider compensation, resource allocation, and diagnostic workflows.
Implication One: Reimbursement Realities
A major factor driving the shift to CTA was CMS’s announcement that it was doubling its reimbursement for CTA, as many assumed this change would make CTA highly lucrative. But even after the increase, CTA reimbursement is still only one-tenth of the reimbursement received for a diagnostic cath. This presents two immediate challenges for cardiovascular service lines:
- Less Revenue per Patient: When more patients are diagnosed via CTA instead of cath, revenue from diagnostic procedures will decline.
- Reimbursement Complexity: CTA scans are often interpreted by radiologists, which can shift revenue outside of the cardiovascular service line. This dynamic creates challenges for budgeting, compensation, and long-term resource planning, especially in systems where cardiologists are not directly involved in the interpretation process.
To address these challenges, health systems must adopt a strategic, proactive approach to cardiovascular financial alignment. Specific tactics could include reconfiguring compensation models to align with evolving procedural mixes and ensure providers remain engaged and evaluating opportunities to shift or expand scan interpretation to cardiac imagers (i.e., cardiologists trained in advanced imaging), where feasible, to keep reimbursement and quality oversight within the cardiovascular service line.
Implication Two: Physician Engagement
For interventional cardiologists, the decline in diagnostic cath volume creates a potential loss of income and cath lab time. Many health systems currently have radiologists reading CTA scans, which means interventional cardiologists lose procedural volume and WRVUs. If CTA adoption accelerates, there's a real risk of provider disengagement, dissatisfaction, and downstream revenue loss for the health system.
Why does this matter financially? Because interventional cardiologists are key revenue generators in cardiovascular service lines. When procedural volumes decline and engagement wanes, referrals can shift, case volumes may stagnate, and overall service line performance can suffer. Conversely, when cardiologists remain supported through change, they help drive new growth areas, such as structural heart procedures, complex interventions, and referral optimization, which can offset diagnostic revenue losses.
To mitigate these risks and maintain financial sustainability, forward-thinking health systems are already:
- Reallocating interventional cardiologists to higher-value procedures (e.g., structural heart interventions, complex PCI) where margins are stronger and clinical value is clear.
- Strengthening referral pathways to ensure interventionalists remain engaged in patient care.
- Evaluating alternative revenue streams to maintain financial sustainability.
Ultimately, sustained provider engagement isn't just a workforce issue—it’s a strategic and financial imperative. Keeping proceduralists engaged and involved is essential to protecting and growing revenue across the evolving cardiovascular continuum.
Operational Implications
While financial planning is critical, the operational side of the CTA transition presents its own set of challenges—and opportunities. The ability to operationalize CTA as a core part of the diagnostic workflow will determine whether the clinical and financial benefits are truly realized.
Implication One: Scan Interpretation Ownership
One of the main logistical challenges related to CTA lies in identifying which clinicians should be responsible for interpreting CTA scans. In some settings, radiologists handle interpretation, effectively shifting oversight of cardiac diagnostics away from cardiology. In others, cardiac imagers are stepping into that role.
From a service line perspective, keeping scan interpretation within cardiology offers key benefits: it maintains continuity of care and allows for quicker movement to downstream intervention when appropriate. That said, this model can put pressure on existing cardiology staff, create training demands, and introduce inefficiencies if imaging resources or skill sets are lacking.
Determining ownership of CTA is a foundational question for long-term planning; yet, the authority ultimately lies with cardiologists themselves and, potentially, payers—not health system executives. Cardiologists typically dictate how imaging is integrated into their clinical approach, while payers may influence who is reimbursed for interpretation. As reimbursement guidelines shift, certain specialties may be favored, or credentialing standards may evolve, shaping how this space develops in the years ahead.
Implication Two: Access Bottlenecks
Ironically, many organizations still face significant challenges in making CTA widely available. Despite being a noninvasive procedure, scheduling backlogs for CTA are often longer, particularly in environments with constrained imaging capacity or where there's a shortage of qualified readers. As such, cardiovascular service lines must tackle several operational hurdles. This includes optimizing scheduling protocols, ensuring imaging capacity, streamlining referral pathways, and addressing staffing constraints that contribute to delays.
Without timely access, referring providers may default to cath procedures—not because they are the best option, but because they are easier to schedule. Reducing CTA wait times not only improves the patient experience, but also supports broader adoption of this modality and ensures health systems fully capitalize on the ongoing move away from more invasive diagnostics.
The Shift to CTA Is Underway: Is Your Health System Ready?
The next few years will bring a seismic shift in cardiovascular imaging. Health systems that proactively adapt to the transition to CTA will be best positioned to succeed. Key priorities should include:
- Developing a strategy for managing cath lab volume declines by shifting interventional cardiologists toward higher-value procedures.
- Ensuring a financially sustainable service line by aligning compensation models and exploring new revenue opportunities.
- Clarifying who owns cardiac imaging—cardiology or radiology—and optimizing interpretation workflows accordingly.
- Expanding CTA capacity to meet demand and ensure timely access for patients.
- Investing in AI and imaging advancements to further enhance CTA’s diagnostic accuracy.
CTA is not just a clinical advancement—it's a signal that the economics and workflows of cardiovascular care are evolving. The systems that succeed will be those that treat this shift not as a discrete operational issue, but as a strategic opportunity to reimagine diagnostics, reengage providers, and realign financial models for the future. Inaction is a risk; now is the time to lead with intention.
Next in the Series: Rethinking the Cath Lab: What Happens When Diagnostic Caths Decline?
Stay tuned for the next installment in our series, where we'll explore how health systems can reallocate cath lab capacity, maintain physician engagement, and optimize procedural workflows in response to this shift.
Edited by Emily Johnson
