Cardiovascular Business - May/June 2008 - (Page 10)

“We’ve established CTA’s diagnostic accuracy. Now we need to prove that it’s clinically useful.” James a. Min, MD, Weill Cornell Medical College, lead author of a study presented at the aCC meeting scanner in the new heart hospital, but which iteration of technology has not been decided. “We are in constant contact with consultants as to the state-of-the art and we want to remain flexible,” says Charles P. O’Brien, MD, president of Sanford and an invasive cardiologist. The projection for year 2009 cath lab procedures is this: ■ 3,329 diagnostic caths ■ 1,258 interventional caths ■ 918 electrophysiology cases, and ■ 3,999 peripheral cases Within five years, O’Brien expects the number of diagnostic caths to top 5,000. How will cardiac CT affect those numbers? He’s not sure yet, but he knows that his region is in the midst of a growth spurt, that his cardiovascular business is increasing and that CTA must fit in somewhere. What to buy “We have to recognize that cardiovascular disease is the No. 1 Practices that incorporate CT “anticipate spreading lease or cause of death in the U.S. and the need for an accurate diagnosis debt payments over the course of 60 months to keep equipis key to manage these patients,” says Tom Stys, MD, Sanford’s ment expenses in reasonable relationship to revenues,” accordmedical director of cardiovascular services. “CTA complements ing to Timothy M. Bateman, MD, at Saint Luke’s Mid America many different technologies, so we know we have to make a place Heart Institute in Kansas City, Mo. (J. Am Coll Cardiol Img for it.” 2008;1;111-118). This financial arrangement was problematic O’Brien and Stys also like CT for what it can do beyond diwith early adopters of 4- and 16-slice technology, Bateman agnosing coronary artery disease. They will most likely include says, because of the rapid depreciation of the scanners upon the CTA in the new cath lab. “Having CT in the cath lab allows you introduction of 64-slice scanners. How long 64-slice CT will to see into lesions better, particularly remain cutting edge remains unclear, single and double occlusions,” Stys says. particularly with dual-source scanning– “Knowing the composition of the plaque, which uses two x-ray sources that deliver whether there is more or less calcium, will a higher temporal resolution–from Sie› CCTA: A Good Value allow interventionalists to be more accumens Healthcare and a 320-detector row Medicare reimbursement rate with their wires.” CT is much more scanner from Toshiba America Medical rates for the 2008 calendar than a triage tool, he said. Systems. year are set at: While the nature of rapidly changSanford USD Medical Center in Sioux ■ Coronary CTA: $650 ing technology might keep many faciliCity, Iowa, is in the midst of constructties like Sanford USD Medical Center ing a Heart and Vascular Hospital to be ■ SPECT myocardial from committing to a particular piece attached to the main 500-bed medical perfusion imaging: $1,096 of equipment, it hasn’t dampened their center. They currently perform about 250 ■ Invasive coronary commitment to having the best cardiocoronary CTA exams per year and would angiography: $2,860 vascular imaging technology. Today, do more if insurance covered more indithat has to include CT. cations. They will install at least one CT who undergo SPECT initially incur lower healthcare costs than if they’d had a first-line CTA study. A study from researchers at Cardiovascular Medical Group of Southern California found that the volume of SPECT imaging dropped significantly by 15 percent within the first year after the integration of a 64-slice CT scanner into an office-based practice. Standard treadmill testing significantly decreased as well, while exercise echo volume increased slightly. Interestingly, net office income did not decrease significantly. Ronald P. Karlsberg, MD, reported at the ACC meeting that the potential for further reduction in SPECT imaging is substantial and that “coronary CTA as the first and often only test for the intermediate-risk patient warrants prospective study.” 10 Cardiovascular Business May/June 2008

Table of Contents Feed for the Digital Edition of Cardiovascular Business - May/June 2008

Cardiovascular Business - May/June 2008 Contents First Word Cover Story - Coronary CTA: Drafting the Strategic Plan Financing New Technologies: Early Adopters, Lease vs. Purchase, and Joint Ventures Clinical Study Digest: ACE or ARB: It's Your Choice Can Off-Hour D2B Times Be Reduced Without Breaking the Bank? Digital Image Management Primer: Integrating Echo SPECT/CT for Cardiac Disease Detection: An Economic Conundrum Integrating the Healthcare Enterprise Connects IT Systems News & Views Calendar Reader's Resources The Back Page

Cardiovascular Business - May/June 2008

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