Cardiovascular Business - May/June 2008 - (Page 7)

Coronary CTA Drafting the Strategic Plan ncorporating coronary CT angiography into a cardiology practice’s imaging mix requires a thorough understanding of many things including potential turf issues, siting requirements, workflow and reimbursement. Despite these challenges, cardiovascular programs can maintain a competitive edge by incorporating coronary CTA, especially given the current environment of stiff competition, personnel shortages, overworked staff and decreased reimbursement. “If you are not developing a business plan for coronary CTA implementation, then you’ve already fallen behind,” says Susan Heck, vice president of Corazon, a Pittsburgh, Penn.based consulting fi rm that specializes in cardiovascular program development. Bringing coronary CTA onboard is a very strategic decision, Heck says, much more than a simple equipment purchase. Some aspects to consider are: ■ Where will the scanner be located? ■ Who will buy it? ■ Who will read the studies? ■ What competency and credentialing criteria will be used? Coronary CTA has proven valuable to triage low- to intermediate-risk patients with acute chest pain. Should the scanner, therefore, be located in or close to the emergency department? CT also has excelled in pre- and post-operative evaluation of patients undergoing percutaneous or conventional heart surgery. Should the scanner sit within the cardiology department? Generally, cardiology won’t fi ll up the CT scanner’s schedule with enough daily coronary artery exams, so the scanner’s time must be shared with general exams. Should the scanner be located in radiology? Will it be used in the outpatient setting or be used in an independent diagnostic testing facility? Are there legal hurdles related to self-referral? What are future plans for the hospital and the technology? Without answers to (Opposite page) a concern of payors is that coronary CT will be used inappropriately as a layered test. Three-dimensional volume rendering acquired in a single heart beat with a 320-detector CT system (aquilion One, Toshiba america Medical systems). (source: Frank J. rybicki, MD, PhD, Brigham and Women’s Hospital) I these questions, practices are setting themselves up to fail. “I’ve seen practices have to go back to square one because they didn’t conduct a thorough business plan before they bought their scanner,” says Heck. William Beaumont Hospital in Royal Oak, Mich., has eight CT scanners to service the 1,061-bed teaching hospital. One scanner sits in the Heart and Vascular Center, the other seven belong to radiology. Beaumont avoided turf issues in the Heart and Vascular Center by combining cardiology, interventional radiology and vascular surgery, according to Ralph Gentry, RT, supervisor of cardiac MRI and cardiac CT. The center also saved on siting costs by converting a pre-existing cath lab into a CT suite. An MRI scanner is within close proximity. Gentry calls the center a true one-stop-shop for cardiovascular patients. Because coronary CTA studies at Beaumont do not keep the scanner busy, the center augments its use with general CT studies, such as chest and abdomen. For coronary CTA, cardiologists read the coronaries, while radiologists overread the thorax. Fees are split: cardiologists get the technical fee, radiologists get the professional fee. Payback Three of the biggest challenges of coronary CTA are reimbursement, reimbursement and reimbursement, says Cathleen Biga, president and CEO of Cardiovascular Management of Illinois, a cardiology physician practice management company. The reimbursement world for coronary CTA is unique to each state. › “T” Codes for Cardiac CT 0144T—calcium scoring 0146T—coronaries 0145T—cardiac morphology 0150T—noncoronary congenital studies 0147T—coronaries, calcium scoring 0148T—coronaries, cardiac morphology 0151T—ventricular EF, wall motion CardiovascularBusiness.com Cardiovascular Business 7 http://CardiovascularBusiness.com

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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