Using coronary calcium scoring as part of an early coronary artery disease detection and heart attack prevention program is an effective way to enhance CT departmental revenue while positively impacting the community.
Coronary calcium scoring has been used for years to identify early stage coronary artery disease, dating back to electron-beam CT technology. With the recent paradigm shift toward early coronary artery disease (CAD) detection and an emphasis placed upon heart attack prevention, coronary calcium scoring becomes a cost-efficient screening technique with supported clinical value.
Prior to recently published coronary calcium scoring (CCS) clinical data, CCS operators relied heavily on a “direct-to-consumer” model to recruit patients. Initially, tens of thousands of dollars were spent annually on direct marketing to consumers via television, radio and print advertisements. These ads focused on the risks of CAD, the benefits of early detection and the low-cost of the non-invasive CCS test.
In 2006, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force Report was published, which provided clinicians with data suggesting appropriate patient selection for CCS testing and how to interpret and utilize CCS test results. This landmark paper, combined with the low marginal cost of CCS testing, prompted us to develop a more clinically-driven CCS model.
Education is key
The clinical model of CCS focuses on educating the primary-care physician and self-insured employers versus advertising direct to consumers. The educational components are guideline-based and stress the importance of early CAD identification, appropriate patient selection and patient outcomes/patient management.
The primary-care setting is ideal to reach those asymptomatic patients deemed appropriate by the SHAPE guidelines. Many primary-care providers are looking for tools—geared toward early disease identification—to better manage their patients.
Self-insured employers also are receptive to CCS education as a method of providing their participants a cost-effective test to identify those at risk for major acute events. CCS can be offered to employees as a part of a wellness program or an incentive of their health plan.
The transition from a direct-to-consumer advertising model to a clinically-driven CCS program dramatically affected our CCS volumes (see Table 1). A comprehensive educational approach designed to promote buy-in from the primary-care physicians and self-insured employers increased CCS referrals substantially. Additionally, by adopting the clinical model versus the direct-to-consumer advertising approach, we eliminated our robust marketing/advertising budget, thereby increasing our profitability per scan, immediately.
Pricing for profit
The price point for a CCS test is a critical component of a successful CCS program. There are tremendous variances in the price charged for CCS across the U.S., ranging from $79 to $699. Our own experience was to initially price CCS at $199, which met with only marginal participation. After lowering our CCS price to $149, and eventually to $99, we found that our volumes increased linearly.
Numerous other sites have reported that CCS pricing below the $100 threshold has positively impacted study volumes. The marginal cost of conducting a CCS test is approximately $7 without a radiology overread (approximately $32 with overread services). Therefore, sites can profitably offer the CCS test at a lower cost while recouping revenue via increased study volumes (see box, above).
The additional benefit of lowering CCS pricing is that a larger percentage of the local population will have access to this test, positively impacting community-wide heart attack prevention efforts.
The largest economic impact of CCS is not profit generated at the time of testing, but rather from downstream revenue. We conducted a six-month analysis looking at both models in our practice. We included all CAD-related CPT (current procedural terminology) revenue resulting from anyone entering our practice via CCS.
Our CPT-driven downstream revenue was significantly higher when using our education-based clinical model to increase CCS referrals (see Table 2). This is likely attributable to the fact that under the direct-to-consumer advertising model many patients would not follow-up with their primary-care physician regarding results. Under the clinical model, in which the patient is referred via primary