PET Helps Cushion Nuclear Reimbursement Cuts

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Anthony Haddix, COO of Orlando Heart Center in Orlando, Fla.

Orlando Heart Center, a 23-physician four-office practice close to Orlando, Fla., prepared for the 2010 reimbursement cuts by investing in a PET scanner. The center since has shifted more SPECT patients to PET,
resulting in multiple benefits for the practice and patients.

Until the 2010 Medicare reimbursement cuts, the practice averaged 5,500 nuclear tests per year on its four dual-head cameras. Last year, it performed about 2,400 PET studies, according to Anthony Haddix, the center’s COO.

CVB: How did you decide to bring PET imaging into the practice?

Anthony Haddix: At the 2008 American College of Cardiology meeting, speakers warned about the upcoming Medicare reimbursement cuts. While it was unclear what would happen with reimbursement, we knew it would have a negative impact, particularly in nuclear cardiology. We decided to investigate PET. We were impressed with how PET promised to be more beneficial in certain patient populations, have better image quality than SPECT and deliver a lower radiation exposure because of the short half-life of rubidium-82. Thus, we conducted site visits, secured the scanner, remodeled our facility and made it operational.

CVB: What are the radiation exposure considerations?

Haddix: Many U.S. facilities for SPECT imaging use technetium-99m or thallium-201 for either a dual-isotope protocol or a low-dose/high-dose rest/stress technetium study. A dual-isotope study has approximately 66 percent more radiation exposure than a rubidium-82 PET study, and a low-dose/high-dose rest/stress study has about 25 percent more radiation exposure.

CVB: You earlier mentioned better image quality. Can you be more specific?

Haddix: The sensitivity and specificity of a PET study is about 12 to 15 percent higher than a nuclear stress study. If a nuclear study is equivocal on a patient with cardiovascular risk factors, many physicians will send those patients to the next testing level, which is catheterization. If a PET study is normal, even in patients with a body mass index (BMI) greater than 32 and multiple risk factors, there is usually no need to perform any further testing. That gives our physicians greater confidence when interpreting PET studies and deciding about patient management.

Side-by-side, a PET study is more expensive to the practice than a nuclear study, and the patient’s co-pay could be higher for private payors. However, in the long run, PET saves insurance companies money because it results in fewer potentially unnecessary catheterizations and fewer repeat imaging tests.

In addition, with PET, we can send more patients through our lab because the test takes roughly an hour from start to finish, compared to 3.5 to four hours for SPECT. Patients are significantly more satisfied with their PET experience and we have better throughput.   

CVB: Is there a particular patient population for which PET imaging is most beneficial?

Haddix: PET is particularly beneficial in patients with a BMI greater than 32, those with protruding stomachs and barrel chests, and in women with large breasts. The high energy of rubidium is especially good for transmitting through large dense objects and is more superior than SPECT tracers for those on the heavier size. Last year, we conducted a correlation study, examining patients who had had an equivocal nuclear test and then went on to have a PET scan. In those with a BMI greater than 32, PET scans were normal and those patients did not have to undergo catheterization. Also, we are sending more people to PET who are scheduled for a nuclear pharmaceutical stress test, but meet the criteria for PET.