|This triple rule out cardiac image was captured on the Somatom Definition Dual Source CT without the use of beta blockers at a heart rate of 90bpm. The image was processed on the Siemens syngo MultiModality Workplace. Image courtesy of Siemens Medical Solutions and Nagoya City University Hospital, Nagoya, Japan.|
Insurers and the government may not be on board, but the medical community sure is: when it comes to improving patient care, cardiac CT is a must-have technology. But depending on the size and scope of your practice, department or hospital, the business case is a little less clear. Clouding the picture are uneven reimbursement rates across the country, the steep learning curve toward reading proficiency and the expense of the equipment and third-party advanced visualization software.
Armed with an understanding of the barriers to entry as well as the potential clinical applications and cross-practice uses, hospitals, physician groups and imaging centers are either actively investing or seriously considering investing in 64-slice cardiac CT technology. Whether a particular facility can sustain a consistent enough patient flow so that the technology pays off depends on a number of factors, including the number of physicians practicing there, the expertise of the technological and IT staff and the variety of procedures performed. And the state of reimbursement in the area weighs in heavily, too.
With cardiac CT enthroned as a state-of-the-art technology and with the current 64-slice and dual source systems representing a substantial improvement from the previous 16- and 32-slice scanners, the question is really not if, but when, you’re going to adopt the technology. If you wait too long, your competitors may be so far ahead of the curve that you’re left in the dust as your referral base becomes more aware of the technological capabilities and demands it for their cardiac patients.
Not only are the diagnostic gains huge when compared with other technologies, but a facility with a well-thought out plan, a sufficient number of physicians and a steady flow of patients can make the return on investment pay off in a year. “Some groups don’t make money in the first year, but there are plenty that do,” says Tony DeFrance, MD, an interventional cardiologist and medical director of CVCTA Education, an independent cardiac imaging company.
For James Min, MD, assistant professor, Division of Cardiology and Radiology at Weill Cornell Medical College, who practices at New York Presbyterian Hospital in New York, N.Y., the potential preventative power of cardiac CT demands widespread acceptance by providers and payors. “This tool is the most significant advance in cardiac imaging in the last 20 years and has incredible potential to prevent sudden cardiac death in patients who previously wouldn’t have been picked up,” he says. “Think of how much death and disease we can prevent if we put our resources towards tools like this that are aimed at prevention.”
From payor to payor and region to region, reimbursement practices may either spur you on to add cardiac CT services—or not. The good news is that the Centers for Medicare and Medicaid Services (CMS) is expected to deliver a decision memo on Dec. 13; that memo will be based on feedback given during a 30-day comment period that ended July 13. Following the decision memo, CMS is scheduled to complete a national coverage analysis by March 12, 2008.
The bad news is that local reimbursement varies depending on the individual guidelines issued by the local Medicare carriers (LCM) in each state. Private payors are divided on the reimbursement issue—some are covering selected types of procedures, while others aren’t covering much at all or are still studying the issue.
The result is a potentially nasty headache for physicians looking to invest in the technology because local differences in reimbursement can make or break you in your bid to at least break even on the investment. “In Alabama, Blue Cross/Blue Shield is reimbursing for CTA and since they cover a high percentage of the population there, it’s a good environment there as is Minnesota, Arkansas and New York,” says Michael Zucker, FACHE, president of Partners Imaging, a joint venture cardiac CT company in Dallas, Texas. “But if you’re in Arizona or California, some major payors aren’t reimbursing, so it can be tough.”
Costs of Adoption
Depending on the vendor and whether you purchase third-party software and workstations,