Cardiovascular Business - October/November 2007 - (Page 8) this 60-year-old male presented with severe chest pain. the gated chest pain protocol on the Siemens Somatom Definition Dual Source Ct enabled the immediate visualization of the entire thorax as well the coronary arteries without motion artifacts. A Stanford type b aortic dissection was identified. the image was acquired without the use of beta-blockers, despite the patient having a heart rate varying between 46 and 89 bpm. the image was processed on the Siemens syngo multimodality Workplace. Image courtesy of Siemens medical Solutions and university medical Center Grosshadern/munich, Germany } cheaper and faster,” he says. “They’d like to send all the patients for a cardiac CT, but we have to finish the study and prove with evidence-based medicine that this really works.” Ideal Facility Size There’s disagreement about the size of a group practice or hospital needed to sustain enough work so that cardiac CT pays off. It also depends on the specialties in a group of cardiologists, the types of procedures and local reimbursement patterns. “If you’ve got a group that focuses mainly on cardiac care, I’d say you need at least 10 cardiologists to make it work,” says DeFrance, who also is a board member of SCCT and a board certified interventional cardiologist. “But if you’ve got some peripheral vascular specialists, you could have fewer physicians. There’s a group in Houston with six physicians who are doing well with their scanner—they do a ton of peripheral vascular [cases].” DeFrance is in solo practice but partners with a group of 14 cardiologists and one radiologist; together they do approximately 3,500 scans a year. Min, agrees, saying “Hospitals and large groups can make it work, especially if they look outside the box for as many potential uses as possible, such as peripheral vascular. But currently, the environment is difficult—either the payors are going to have to pay more or the vendors are going to have to charge less because economically it isn’t sustainable. Right now, I don’t think small and medium sized groups can make it work financially.” Min’s department conducts between 1,000 and 2,000 scans per year; he uses a GE LightSpeed VCT with SnapShot Pulse and a GE Advantage Workstation. The New York Presbyterian Health System has 2,335 beds and 174 cardiologists. In states such as Arizona where the reimbursement environment is difficult, measurement of calcium scores for intermediate risk patients is one way a group or hospital can make the technology pay, says Zucker. Joint ventures between groups of cardiologists and other specialists, such as urologists, oncologists, neurologists and orthopedists also can make the technology affordable. Companies such as Partners Imaging will work with practices and set up joint ventures, providing assistance with financing, construction, installation, staffing and reimbursement if a particular practice and market looks promising enough. Educating primary-care physicians as to the benefits of the technology is absolutely critical to success, says James Adams, MD, FACC, a cardiologist at Cardiovascular Associates of Marin and San Francisco in Larkspur, Calif., and a principal in Civic Associates, a CT training firm. “You have to educate local primary-care doctors about the technology because they are your referral network,” he says. “It’s all about being a good consultant and helping your customer take better care of his or her customer. This is the responsible way to run a practice rather than the groups that are just out for volume.” Cardiovascular Associates has 12 cardiologists and three surgeons in the practice and uses the TeraRecon Aquarius workstation. In a year’s time, the practice performs approximately 1,200 calcium scans, 500 cardiac angiograms and 300 peripheral vascular CT scans. The practice is affiliated with the Marin Heart Institute. Work Flow With trained staff, most facilities can handle four or five patients an hour; six patients an hour is possible, but stretching the capabilities of the staff and the technology, says Flamm. From the patient’s point of view, the test takes about an hour and is much less invasive and time-consuming than a trip to the cardiac cath lab, just as it is less time consuming for the physician. Keeping the scanner and the related staff busy is the key, says Adams, as is avoiding turf wars with other specialties. For Schwarz, the threshold for justifying installing the equipment is 10 cases a day, even at the currently low levels of reimbursement. Not only is trained staff key, but the cardiologists and radiologists also must make the investment so that they can read and interpret the scans without getting backed up. “You need at least one partner trained in cardiac CT to make it work and for that person to get really up to speed they need to have read 500 cases, but you can definitely interpret cases at the end of a training course,” says Schwarz. Despite the barriers to entry, cardiac CT has incredible promise, some of which is already being realized. “I’m very bullish about the technology,” says Zucker. “The patients can get in and out quickly, there is no doubt that it improves patient care and the efficiencies will save money for payors. It is a genuinely revolutionary technology.” Cardiovascular Business october/November 2007
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.