Cardiac PET Reimbursement Takes a Hit

A few months ago, I read in the Federal Registry that Cardiac PET studies will see a 23% cut in reimbursement for 2011.  This looks pretty dramatic but one thing to consider is that in 2010, Cardiac PET studies saw a 20% increase.  It is this kind of unpredictability the makes it hard for a CFO to project a budget.  Is it just a readjustment by CMS or is there another reason for the change?

I did some checking, and other than labor, there are two primary costs associated with Cardiac PET studies: capital costs and the Rubidium-82 radioisotopes.  According to the MD Buyline database, capital costs for PET and radioisotope generating technology have been fairly stable over the last few years.

The consumable portion of the radioisotope generator costs between $29,000 and $32,000, depending on how well you negotiated.  As with all radioisotopes, it has a half-life and has to be replaced every 28 days even if all the dosages are not used.  So with PET technology, the cost of generating a radioisotope drops with higher utilization.  CMS tracked the cost of Rubidium-82 and it dropped 21% ($420 to $330) in the last year primarily due to the increased utilization.

Improved outcomes are another driving force behind the increased interest in Cardiac PET studies.  A recent study indicated that PET produces a sensitivity of 0.92 and a specificity of 0.85.  The study concluded that the technology was superior to coronary MDCT angiography or MRA for the diagnosis of CAD.

So what lies ahead for Cardiac PET studies?  Based on MD Buyline’s market activity data, the purchase of PET capital equipment increased 25% over the last year.  In addition, Bracco Diagnostics, one of the leading suppliers of Rubidium-82 radioisotopes (CardioGen-82), also reported a 46% increase in the number of clients in the last six months, indicating that Cardiac PET studies will continue to grow.  Just be aware that you need the numbers to ensure the reimbursement will cover your costs.

James Laskaris, EE, BME
ABOUT THIS EXPERT
James Laskaris, EE, BME, Clinical Analyst — Mr. James Laskaris is a senior emerging technology analyst at MD Buyline and has been with the company since 1994. With over 30 years of experience in the healthcare field, Mr. Laskaris is the primary analyst of high-end OR technology. He also covers issues related to the legislative and reimbursement effect on healthcare and authors a bimonthly “Issues that Matter” publication. Mr. Laskaris received his biomedical engineering degree from Southern Illinois University. His work has been published in hfm Magazine, Radiology Manager and Healthcare Purchasing News.