I once sat down with a representative from a large IDN to discuss his experience with a 64-slice CT system. I asked him, “So, you purchased a 64-slice CT system instead of a 16-slice system because you wanted to do cardiac CTA, right?"
He chuckled a little bit and went on to say “Yeah…that’s what we thought we were going to do. Purchasing cardiac CTA capability was one of worst investments I ever made, and if I had it to do over again, I wouldn’t."
That conversation motivated me to ask others to share their experiences regarding cardiac CTA whenever I had the opportunity. I have learned a great deal from these discussions and I want to take a few minutes to pass along 3 things you need to know about cardiac CTA before you buy.
“We can make up the expense with the additional referrals cardiac CTA will bring in."
When I hear this it is generally from a radiology administrator and my first response is to ask: “Is your cardiologist on board with this?" This is an important consideration because, in most circumstances, this will be the referral source that will feed the new service.
If the answer is not, “Yes, our cardiologists are on board and working with us to make this happen," I recommend against moving in this direction. Circumstances and structure vary from institution to institution but it is safe to say that most cardiologists do not consider cardiac CTA the diagnostic tool of choice. So, if they are not part of the plan, the plan will probably not work.
Of all CT procedures performed in the United States less than 9% are cardiac CTA. Of those, it is safe to speculate that less than half are reimbursed. Cardiac CTA is not part of a traditional chest pain protocol and when a patient presents to the ED chances are slim to none that they will receive a cardiac CTA. Currently, CMS considers cardiac CTA an unnecessary expense and only reimburses for it in very select situations. This, at best, prolongs the time between purchase and ROI for a CTA-enabled scanner.
In addition to the cost of cardiac functionality for the CT system, there are some ancillary costs to consider. Cardiac monitoring equipment and staff training will be necessary. This equipment and skill set are probably not native to a radiology department that is not already doing cardiac procedures.
There is also the issue of beta blockers. Quite often the patient’s heart rate must be slowed for a diagnostic study to be possible. These drugs cannot be administered and monitored by just anyone and will require some specialized staffing considerations. The unfortunate reality is that most patients that need a cardiac CTA do not have a heart rhythm that makes getting a good study easy.
These additional costs associated with doing cardiac CTA are very specific to the niche. Because of this, they can't be offset by other areas of your CT business.
If you have a detailed plan to drive cardiac CTA referrals to your facility, the capability can allow you to fill a niche that, under very specific circumstances, can pay off for your patients and your practice.
If you don’t have a plan to drive referrals, the investment is not likely to generate considerable revenue. This is especially true in light of the limited circumstances in which CMS reimburses cardiac CTA and the specialized equipment and staff training that will need to be purchased or hired in.
Remember, the hospital as a whole can do just fine performing ultrasounds and cardiac catheterizations. Introducing cardiac CTA will require compelling reasons and carefully laid plans.
Courtesy of guest contributor: Keith Mildenberger
Keith has been in the diagnostic imaging business since 1983. Having held service, management, marketing, and sales positions, he has developed a broad base of experience in areas impacting the diagnostic imaging community and the patients it serves. He has been part of MITA since 2011 and involved with all aspects of NEMA XR-29, including its authorship. He is currently the CT Product Manager for Neusoft Medical Systems USA, Inc.