NEW ORLEANS - Potential PET utilization has increased nearly tenfold, however, practice volumes haven't kept pace with the growing range of applications. In a presentation at the Society of Nuclear Medicine meeting, PET practice expert Susan Minerich offered insight and suggestions for building a successful PET center.
Minerich, a certified nuclear medicine technologist with more than 20 years of clinical experience, currently develops PET practices for radiopharmaceutical provider P.E.T.Net Pharmaceuticals, a subsidiary of CTI Molecular Imaging of Knoxville, TN.
"We know that the breakeven point for our return on investment is between three and four patients a day. We know that most PET centers aren’t doing that. PET remains, in the imaging world, very underutilized. We’re doing less than 0.5% of the total imaging procedures in the U.S.," Minerich said.
In the past five years, Medicare coverage for the modality has become much more generous. The most commonly used radiotracer, 18-FDG, is now available in approximately 95% of the U.S., and PET scanners have been installed far beyond the bounds of academic institutions. But the utilization rate has not kept pace with these developments.
"What’s really missing in this picture is medical adoption. We need to address that if we’re going to be at all successful," she said.
Minerich conducted a four-month study composed of referring physician interviews to assess the barriers to PET use. She found that the top ten referring physicians characteristically represent 50% of a practice’s total monthly volume, and that only 10% of the referring physicians order one or more scans per month. Her group also found that 45%-55% of the referring physicians order only one PET procedure per year.
In talking with the referring physicians (medical oncologists, thoracic surgeons, surgical oncologists, pulmonologists, and radiation oncologists) she found a few common themes in their reluctance to order PET procedures.
Quality of the procedure remains unverifiable for many referrers, she said. They are unable to perform an independent evaluation of the images, and there is a perceived variability in the image quality depending on the technology employed (dedicated scanner, crystal type, and coincidence imaging). Also, they expressed a concern over the qualifications of new interpreters in a community-based setting vs. that of an established academic center.
Minerich also discovered that the majority of referring physicians have a limited understanding of the clinical applications of PET.
"Because coverage has been such a moving target for the past five years, many referrers are unaware of what is available for reimbursement. Or, if a procedure is available for reimbursement, that there are no established practice standards or guidelines for the use of PET," she said.
Most important to the referring physicians Minerich spoke with was the need for PET to provide a specific answer to a clinical or diagnostic question. In PET, these physicians are looking for special information that is not evident or available by means of conventional imaging techniques.
"PET needs to be easy to order, easy to understand the results and interpretation, easy to share the results with a patient, and easy to share the results with a colleague," Minerich said.
Another expectation of referring physicians is that the nuclear medicine physician or radiologist performing the PET study will be available as a clinical consultant. This means that the interpreting physician has to understand the clinical management decisions and needs in order to tailor their results to meet the needs of the clinician, as well as the patient who underwent the procedure.
According to Minerich, the key driver of profitability remains daily procedure volumes. However, to achieve a consistent volume of patients, PET practitioners must drive new referrals to their practice and increase utilization among their current referring physicians.
Extensive educational outreach by a PET facility is also needed to increase utilization. This outreach must be conducted on both a professional and community-wide level to be successful.
"It’s incumbent on the interpreting physicians to not only be available for phone consultations, but to initiate phone calls to the referring physicians for follow up on their reports," Minerich said.
In addition, she suggested a presence by the practice at grand rounds, tumor boards, and specialty meetings, as well as hosting diagnostic dilemma roundtable discussions. Clinical reference guides, specialty-targeted peer-reviewed articles, and basic patient information pamphlets should be disseminated to a center’s referring physician base.
Consumer awareness has proven very lucrative for the prescription drug industry, and offers a lesson that PET providers should take to heart, Minerich said. Patient advocacy group presentations by center physicians as well as beneficiary organization support, such as the Susan G. Komen Foundation "Race for the Cure," can help put PET in the forefront of patient’s minds.
Finally, practices must make the investment necessary to make PET access as easy for referring physician as it is for conventional imaging. This means that a center will have to commit the personnel to provide patient screening and scheduling, preauthorization with payors, and offer the referred patient a quality experience from the initial contact to the time of their release. Interpreting physicians will have to move away from the traditional role of the backroom report writer to that of an active, available participant in the clinical decision-making process. All of this will take time and money, according to Minerich.
"You cannot cost-cut your way to success in a PET practice," she said.
By Jonathan S. BatchelorAuntMinnie.com staff writer
June 22, 2003
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