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As demand grows for positron emission tomography (P.E.T.), the choice for many administrators won’t be whether, but how and when to offer this service. In numerous cases, mobile systems will offer the only affordable option, say officials with companies offering this service. Those that don’t find a way to provide this increasingly popular service should expect both patients and the physicians who treat them to go elsewhere, they say. "For most hospitals and clinics, it’s simply a cost issue," said Jill Janik, education director for Mobile P.E.T. Systems. "Mobile P.E.T. allows access to the technology without a huge capital investment." Dedicated state-of-the-art P.E.T. centers can cost more than $2 million, she noted – more if there is significant facility construction involved. Mobile P.E.T., on the other hand, requires only a sturdy pad (concrete or asphalt reinforced with steel plates) on which to park the 45-50,000-pound vehicles. The company currently has 15 units nationwide. And, whereas dedicated facilities must often be financed – sometimes eclipsing any profit for years – companies providing mobile P.E.T. do so for an agreed-upon fee which is reimbursable and may even yield an immediate profit. Alliance Imaging, for instance, charges about $1,000 per scan at one of its 14 mobile P.E.T. units, according to Terry Day, RT (N)(R), unit manager, plus another $400 for an injection of fluorodeoxy glucose (FDG), a radioactive tracer that identifies high-metabolism cells. Typically, he said, the Centers for Medicare and Medicaid Services (CMS, formerly the Health Care Financing Administration) reimburse hospitals roughly $2,500 for these procedures, so the approximately $1,100 difference – less the hospital’s own costs – is its profit. The mobile units arrive with technicians aboard so, in theory, hospitals needn’t do much more than simply get patients aboard. Pushing PET forward Several factors, say providers, are driving P.E.T. demand:
"It hasn’t quite hit the mainstream yet, but when it does you will see patients demanding P.E.T. right up front rather than going through CTs or MRIs or more invasive procedures," said Alliance’s Day. Janik says, "More people are becoming educated about P.E.T. and, when they get educated, they want it."
"People already know, for instance, that UCLA has a P.E.T. scanner whereas another hospital doesn’t," she said. "Of course, there are still many places that will tell patients, ‘You don’t need a P.E.T. scan.’ But now patients are coming back with facts and saying, ‘You may not think I need it, but I want it.’ " Reimbursement changes On top of this came CMS’s July announcement restricting P.E.T. reimbursements to those performed with gamma cameras with 5/8-inch or thicker lenses. (Alliance’s Day thinks this was a mistake and noted that the company’s lobbyists have already urged a change in policy.) The decision is a blow to the many hospitals that had purchased other types of equipment in anticipation of reimbursement for oncology and cardiac procedures. (CMS indicated that it would review its decision on gamma camera-based P.E.T. after Dec. 31, 2002.) While bad news for hospitals, the
decision was at least a temporary boon to the mobile P.E.T. alternative, said
Day. Alliance – and, realistically, any mobile provider – must provide
equipment that meets reimbursement guidelines. On the other hand, he
observed, institutions that invest in their own equipment are stuck with it when
reimbursement guidelines change. According to Day and Janik, use of
mobile P.E.T. can be either a permanent solution or merely a phase. Small
or remote hospitals may never generate sufficient volume to justify a dedicated
facility and, therefore, may find that periodic visits by mobile systems are
adequate. Larger hospitals, on the other hand, are more likely to use
mobile P.E.T. as a tool to snap up market share without having to waiting to
obtain financing and finish construction. "We expect that a lot of our
customers will go to fixed centers eventually," said Janik, who noted
Mobile P.E.T. Systems, like Alliance, is prepared to go into partnership on such
facilities when its clients are ready to make such a move. "What happens is that, once
they get into the market with a mobile system, their volumes keep growing,"
she explained. In addition, mobile P.E.T. is attractive to some major hospitals that have forged alliances with smaller hospitals in their regions, according to Day. Some of these institutions have dedicated systems at their central facilities while also employing mobile systems to serve partner hospitals. Getting word out "From a marketing perspective,
these hospitals want to offer a certain level of care across their
systems," said Day. "What they don’t want to do is be forced
to send people ‘downtown.’ That devalues the value of the
network." Marketing, in fact, is a particular
strength of mobile providers, agreed Janik and Day. Both Alliance and
Mobile P.E.T. support their clients by providing marketing expertise, collateral
materials (brochures, prescription pads) and, most important, experts to stoke
up demand among physicians. "We do lectures at the various
hospitals’ tumor boards," said Day. Most such boards meet weekly to
review cases – particularly complicated oncology cases – and have proven
very effective forums in which to communicate P.E.T.’s advantages, he said. "Once oncologists and pulmonologists see how it changes the management of their patients, and how it can prevent unnecessary surgery, they’re usually eager to use it," he said. Mobile P.E.T. employs a similar physician-outreach tactic, said Janik, as well as free instruction in reading P.E.T. scans. ADVANCE for Imaging and Oncology Administrators / November 2001
 Mark
E. Dixon
757 Upper Gulph Road
Wayne, PA 19087-2022
USA
610-971-0649
dixon_mark@verizon.net
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P.E.T.
is coming and, for many hospitals, it will arrive on wheels
Some,
in fact, say an "explosion" is already underway. In California, the
Academy of Molecular Imaging (AMI, previously the Institute for Clinical P.E.T.)
gets up to eight calls a week from organizations setting up P.E.T. clinics,
according to Kim Pierce, executive director.