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New study explores the significant impact of attenuation correction on downstream costs

Posted on: 09.21.17

Attenuation artifacts present a challenge when interpreting SPECT myocardial perfusion imaging (MPI) studies. Advanced technology has been able to significantly improve diagnostic accuracy through attenuation correction. A team of doctors at Hartford Hospital and the University of Connecticut explored the impact of attenuation correction on clinical decision-making and its effect on the cost of downstream testing.

The goal of the research was to determine if the use of attenuation correction reduced the need for downstream cardiac testing and thus decreased the overall cost of care. The findings of the study on the impact of attenuation correction were featured at the ASNC 2016 Annual Meeting conference in Boca Raton, FL.

Gathering data

The researchers questioned referring providers for hospital inpatients and chest pain unit patients who underwent a clinically indicated stress SPECT MPI over a 1-year period. Twenty-three different providers offered the MPI study results of 90 patients with and without attenuation correction. They were communicated via phone in a blinded, randomized manner along with the determination of whether the patient would be discharged or would remain hospitalized, and if any additional cardiac testing would be ordered. The costs for the additional downstream tests were calculated using the 2015 Medicare fee schedule

The results

The use of attenuation correction resulted in sixteen additional normal studies. Without the use of attenuation correction, an additional nine patients would have remained hospitalized at a significant total cost of $16,200. Interpretation without AC resulted in three additional echocardiograms and twelve additional cardiac catheterizations. The average excess cost per patient for downstream testing was a notable $357.

When considering a hospital patient population, the results of the study present a significant opportunity for savings. Based on the study results, a practice performing 2,500 SPECT studies annually would save the healthcare system nearly $600,000 in unnecessary tests and hospitalizations by using Attenuation Correction.

The bottom line

The results of the study demonstrated how the use of attenuation correction with stress SPECT MPI resulted in a significant reduction in downstream cardiac testing, continued hospitalization, and total cost of care.

Regarding diagnostic accuracy and confidence, the research concluded that attenuation correction is a valuable feature when it comes to SPECT MPI studies. It also proved to relieve some of the burden to the healthcare system by avoiding unnecessary costs and improving the efficiency of patient care. From a revenue perspective, hospitals and providers should also consider using their data to improve their quality scores under the new MACRA reporting since they’ll be able to demonstrate how they provide high quality, efficient care supported by technology.



22nd Annual ASNC Scientific Session Begins September 14

Posted on: 09.07.17

The American Society of Nuclear Cardiology kicks off their 22nd Annual Scientific Session in Kansas City, Missouri. ASNC 2017 will be held from September 14th through the 17th at the beautiful Sheraton Kansas City Hotel at Crown Center.

This year’s highly interactive programming will provide specialized physicians, scientists, technologists, nurses, and many others professionals from around the world with the latest information on nuclear cardiology, its emerging trends and techniques. The specialized curriculum will review cutting edge scientific advances and provide opportunities to learn from the most experienced and well-respected educators in the nuclear cardiology and cardiac imaging industry.

Alongside workshops, lectures, panel discussions, Read with the Experts sessions, and Great Debates, this year’s Scientific Session will also include a lab Boot Camp, which will be critical in helping to strategically position your lab for long-term success, and all-new interactive workstation sessions. In addition, you’ll find an Exhibition Hall packed with the industry’s most advanced technology and quality services.

Digirad is pleased to announce that we will be showcasing the Cardius® X-ACT+ dedicated cardiac SPECT imaging system with Attenuation Correction and debuting information on our Cardiac PET service program at this year’s meeting. Take a minute to stop and visit us at Booth 212. We’d love to see you!



Accountable Care Calls for High-quality Imaging from Nuclear Cardiology – Frost & Sullivan Report

Posted on: 08.29.17

Frost & Sullivan recently published a white paper titled Accountable Care Calls for High-quality Imaging from Nuclear Cardiology that addresses the role payment reform is playing, and how it could potentially affect what constitutes a well-rounded modality and ultimately the best equipment for accountable care.

The paper acknowledges the introduction and planned expansion of new bundled payment structures for complete episodes of care. It also points out that cardiovascular conditions are at the forefront of the payment reform and that any imaging procedures will need to justify their contribution to the care pathway by showing value in the patient outcome.

As a result, physicians’ expectations of nuclear imaging will need to change, whether it’s at the front end or later stages of care. In part, that process will influence the physicians’ and the industry’s acceptance of what constitutes the best nuclear imaging equipment for what is considered accountable care.

Providers will need to strengthen their ability to provide early diagnoses and prognoses, more actionable guidance and risk stratification in their patient care. They’ll also need to be more accessible across the population and provide a more cost-effective solution for their services.

When Frost & Sullivan searched the market for a nuclear camera that could support the needs and satisfy the innovation demands required by the nuclear imaging industry, Digirad’s X-ACT+ was the only solution. As an added bonus, its price point and total cost of ownership were also extremely attractive features.

Download your copy of the Frost & Sullivan White Paper, Accountable Care Calls for High-quality Imaging from Nuclear Cardiology, here.



Healthcare QuickLinks: MPI imaging in women, proposed 2018 MACRA Proposed Rule, and more

Posted on: 08.03.17

Healthcare is ever changing, so it’s important to stay up to date on advancements and issues that may impact the development, operation, maintenance, and growth of your services. Here are some important developments:

Myocardial perfusion imaging in women for the evaluation of stable ischemic heart disease

This document from the American Society of Nuclear Cardiology represents an updated consensus statement on the evidence base of stress myocardial perfusion imaging (MPI), emphasizing new developments in single-photon emission tomography (SPECT) and positron emission tomography (PET) in the clinical evaluation of women presenting with symptoms of stable ischemic heart disease (SIHD). The clinical evaluation of symptomatic women is challenging due to their varying clinical presentation, clinical risk factor burden, high degree of comorbidity, and increased risk of major ischemic heart disease events. Continue reading…

10 things to know about CMS’ new 2018 MACRA proposed rule

CMS released its proposed 2018 regulatory updates for MACRA’s Quality Payment Program. Officially titled, “CY 2018 Updates to the Quality Payment Program,” the rule includes several key policy updates that would impact providers’ participation in MACRA starting in 2018. And at 1,058 pages in length, for those who have other items atop their summer reading list, here are 10 Things to Know about CMS’ New 2018 MACRA Proposed Rule. Continue reading…

Human enzyme may be key to unraveling Alzheimer’s disease

Neurodegenerative diseases already affect millions of people in the United States and by some estimates, in 30 years, there will be 12 million people in the U.S. living with a neurodegenerative condition. These diseases include Alzheimer’s, Parkinson’s, Lou Gehrig’s disease and Huntington’s disease. Protein aggregates are the hallmark of a number of these neurodegenerative diseases. New research, published in the journal PLOS Biology, examines a human enzyme that unravels these disruptive plaques. Continue reading…

Study: Physicians miss early signs of heart disease more often than they should

New research points to evidence that general practitioners could be putting patients at a higher risk for severe cardiovascular outcomes by missing initial signs and symptoms for heart disease that could lead to an early diagnosis. The research, published online in The Joint Commission Journal on Quality and Patient Safety, was conducted by CRICO Strategies, a research and analysis organization, and the Doctors Company, a medical malpractice insurance company. The study included more than 250 closed medical malpractice cases in which patients alleged that a general medical practitioner in an outpatient setting failed to identify cardiovascular disease. Continue reading…

Novel PET tracer detects small blood clots

Blood clots in veins and arteries can lead to heart attack, stroke, and pulmonary embolism, which are major causes of mortality. In the featured article of The Journal of Nuclear Medicine‘s (JNM) July 2017 issue, German researchers show that targeting GPIIb/IIIa receptors, the key receptor involved in platelet clumping, with a fluorine-18 (18F) labeled ligand is a promising approach for diagnostic imaging. Current imaging modalities rely on structural characteristics, such as vascular flow impairment, and do not address the critical molecular components. Continue reading…

Hospital impact—Providers beware: Performance under MIPS can influence overall patient volume

The Merit-based Incentive Payment System (MIPS) is an attempt by the federal government to characterize in a single score the value of a provider’s care relative to other providers. Though the program is not without its challenges and limitations, it does begin to give consumers some information they need to make informed choices and benefit from competition. The healthcare industry is in the position of having this transparency imposed upon it via federal action because the providers themselves have been slow to tackle true accountability. Continue reading…



Circumferential Intravascular Radioluminescence Photoacoustic Imaging ​(CIRPI) system​ debuts at SNMMI

Posted on: 07.13.17

Dr. Raiyan Zaman recently spoke at the 2017 SNMMI Annual Meeting in Denver, Colorado about a revolutionary system that will dramatically improve the early clinical diagnosis and treatment of coronary artery disease (CAD).

The idea that launched the CIRPI System

The Circumferential Intravascular Radioluminescence Photoacoustic Imaging (CIRPI) system is the result of an idea that Dr. Zaman jotted down on a scrap piece of paper one evening so she wouldn’t forget about it in the morning. Thinking about her research, she wondered about the composition of atherosclerotic plaques, which she hadn’t entertained before and considered adding a photo echo-stick to her current work on characterizing vulnerable plaque. That one idea could significantly change the way CAD is assessed and treated. It could also help prolong the lives of a wide number of people by helping to manage their heart disease well before they experience additional, more advanced symptoms.

What is the CIRPI System?

The system includes a unique optic-based probe that combines circumferential radioluminescence imaging (CRI) and photoacoustic tomography (PAT). Not only is it able to locate plaque, but it’s also able to differentiate between stable and vulnerable plaque and determine its composition. Physicians will be able to more accurately assess the clinical situation and decide on the appropriate course of treatment for the patient based on this information.

Currently, there is no imaging modality clinically available that can detect any early stage of vulnerable plaque buildup, including angiography, which can only be used in the advanced stages of plaque detection. It’s unique because it gives the interventional cardiologist substantially more diagnostic information.

When will the CIRPI System be available?

The CIRPI System is still being tested and is expected to move to clinical trials soon. Dr. Zaman estimates that the CIRPI System pilot study should be up and running within three years. In fact, there are already several cardiologists who are looking forward to enrolling several of their patients.

Dr. Zaman’s late night wondering was what won an NIH K99/R00 award that funded her research and eventually led to what may be the most effective method in the treatment and risk management of CAD. We’ll be following her progress and will be excited to report on any updates.



Healthcare QuickLinks: The ambulatory approach, CMS Bundled Payment Rules, and more

Posted on: 07.06.17

The ambulatory approach

There is no disputing the move toward outpatient procedures in the invasive cardiac procedural space. Percutaneous coronary intervention (PCI) shifted from 365,788 inpatient procedures in 2004 to 201,142 inpatient procedures in 2014. This dramatic change represents a 45% decrease in inpatient procedures. Similar numbers can be seen in the electrophysiology service line; from 2004 to 2014, inpatient pacemaker implantations decreased by 49%. According to the Physician/Supplier Procedure Summary report, 2014 was the first year that physicians were paid by Medicare for more outpatient than inpatient invasive cardiology procedures. Continue reading…

CMS issues final rule to delay some bundled payment models

The Centers for Medicare & Medicaid Services (CMS) has finalized a rule to delay the implementation of some bundled payment models. The final rule, posted to the Federal Register on May 19, 2017, pushes back the expansion of the Comprehensive Care for Joint Replacement (CJR) Model, the Cardiac Rehabilitation Incentive Payment Model and the care coordination models. CMS proposed the delay at the end of March. The rule pushes back the effective date for the Cardiac Rehabilitation model and some provisions of the care coordination model from July 1, 2017 to January 1, 2018. Continue reading…

Incorporating population health in next gen of bundled payments

The next generation of bundled payments should focus on population health management, researchers recently argued in a Journal of the American Medical Association report. The authors from the Corporal Michael J. Cresencz VA Medical Center, Perelman School of Medicine, Massachusetts General Hospital, and Leonard Davis Institute of Health Economics pointed out that existing bundled payment models suffer from several limitations. The alternative payment model is based on a fee-for-service payment structure and they incent providers to select the healthiest patients for care to avoid high healthcare costs. Continue reading…

Management of type 2 diabetes in 2017

More than 29 million people in the United States and 420 million globally have diabetes, with a projected global prevalence of 642 million by 2040. This accelerating pandemic comes with high personal and financial costs to the individual, society, and the economy. The expanding number of antihyperglycemic medication options for type 2 diabetes, often involving different mechanisms of action and safety profiles, can be a challenge for clinicians, and the increasing complexity of diabetes management requires a well-informed strategy for prevention and treatment of this disease. Continue reading…

SNMMI partnering with NDSC to disseminate appropriate use criteria

Clinicians referring patients for imaging with nuclear and molecular modalities will soon be able to do so with ready access to utilization assistance that’s based on appropriate-use criteria developed by the Society of Nuclear Medicine and Molecular Imaging (SNMMI). That’s because the group is working with National Decision Support Company (NDSC) to put the criteria in front of these referrers, as long as they use NDSC’s widely adopted Care Select Imaging platform, according to a news release sent by NDSC. Continue reading…

Regulatory Requirements: The impact on cardiac imaging and dose management

In recent years, radiation dose management awareness has heightened across the healthcare industry to address growing concerns around the consequences of too much exposure, and a lack of standardization around dose management protocols and practices. Industry stakeholders have responded by introducing new regulations and requirements for healthcare providers, including the CMS recent MACRA ruling along with updated Joint Commission standards which call for more stringent dose management and reimbursement requirements. Understanding exactly what prompted these changes is paramount for health systems around the world to ensure compliance and success in this evolving environment. Continue reading…

Myocardial perfusion imaging in women for the evaluation of stable ischemic heart disease—state-of-the-evidence and clinical recommendations

This document from the American Society of Nuclear Cardiology represents an updated consensus statement on the evidence base of stress myocardial perfusion imaging (MPI), emphasizing new developments in single-photon emission tomography (SPECT) and positron emission tomography (PET) in the clinical evaluation of women presenting with symptoms of stable ischemic heart disease (SIHD). The clinical evaluation of symptomatic women is challenging due to their varying clinical presentation, clinical risk factor burden, high degree of comorbidity, and increased risk of major ischemic heart disease events. Continue reading…



SNMMI Annual Meeting – Show Preview

Posted on: 05.17.17

Have you registered for the 2017 Society of Nuclear and Molecular Imaging (SNMMI) Annual Meeting? You won’t want to miss the most highly anticipated, educational, scientific, research and networking event in nuclear medicine, especially since it’s being held in beautiful Denver, Colorado.

Mark your calendar for June 10-14, 2017, when you’ll join your colleagues in the Mile High City. The Annual Meeting will host over 5,600 attendees including molecular imaging and nuclear medicine physicians, radiologists, cardiologists, pharmacists, scientists, lab professionals, and technologists. They’ll be representing the world’s top medical and academic institutions from 60+ countries around the globe.

This year’s meeting will deliver a comprehensive assessment of the current and future direction of nuclear medicine and molecular imaging from both a research and clinical perspective. It will also provide an in-depth view of the latest technologies and will showcase more than 160 of the top nuclear medicine and molecular imaging products and service providers, including Digirad.

Visit Digirad at Booth 717!

We’re proud to be exhibiting the Ergo, X-ACT+, and QuantumCam at the 2017 SNMMI Annual Meeting. You can find us at Booth 717 so be sure to stop by and see us!



QuickLinks: MIPS, PET Radiotracer design, bone scan guidelines, and more…

Posted on: 05.09.17

Healthcare is ever changing, so it’s important to stay up to date on advancements and issues that may impact the development, operation, maintenance, and growth of your services. Here are some important developments:

Docs risk reputation damage by reporting minimal MIPS data

This year, physicians can avoid a payment penalty in the Medicare Quality Payment Program by simply submitting a minimal amount of data. But that small amount of data could cause a bigger problem in 2019. In the first year of the program, under the Medicare Access and CHIP Reauthorization Act (MACRA), physicians can ease their way into the program requirements. Under MACRA’s Merit-based Incentive Payment System (MIPS), physicians can submit as little as one quality measure improvement activity for any time period in 2017 and avoid a financial penalty. The more data they submit, the more potential to earn a payment incentive. Continue reading…

Read with the experts: Molecular brain imaging of dementia

On Monday June 12, 2017, at the Society of Nuclear Medicine and Molecular Imaging Annual Meeting, Brain Imaging Council will sponsor a CE Session entitled Molecular Brain Imaging of Dementia. Upon completion, participants will be able to: 1. Examine brain PET and SPECT findings typically seen in Alzheimer’s disease, frontotemporal dementia, dementia with Lewy bodies, and other types of dementia. 2. Use different brain imaging modalities for dementia workup. 3. Describe new imaging methods. Continue reading…

PET radiotracer design for monitoring targeted immunotherapy

In an article published in the April issue of The Journal of Nuclear Medicine, researchers at Stanford University in California provide a template for assessing new positron emission tomography (PET) radiotracers that can accurately identify molecules in cancer cells that prevent the immune system from attacking the cancer. A drug that blocks a cancer’s inhibitory checkpoint molecules is called an immune checkpoint inhibitor and this form of immunotherapy has emerged as a promising cancer treatment approach. However, the lack of imaging tools to assess immune checkpoint expression has been a major barrier to predicting and monitoring response to a clinical checkpoint blockade. Continue reading…

Recommendations on the echocardiographic assessment of aortic valve stenosis

Since detailed recommendations for the echocardiographic assessment of valve stenosis were published in 2009, numerous new studies on aortic stenosis have been published with particular new insights. This document focuses in particular on the optimization of left ventricular outflow tract assessment, low flow, low gradient aortic stenosis with preserved ejection fraction, a new classification of aortic stenosis by gradient, flow and ejection fraction, and a grading algorithm for an integrated and stepwise approach of aortic stenosis assessment in clinical practice. Continue reading…

Top hospital CEO concerns: Outpatient care access, innovative ways to cut costs

Hospital executives are looking for innovative ways to control costs at the same time that they grow service lines to remain competitive in a consumer-driven world. A new survey from The Advisory Board indicates that the top concerns of hospital and health system C-suite executives are to improve patients’ access to care in ambulatory or outpatient settings and also find innovative ways to reduce expenses. The survey, conducted between December 2016 and January 2017, asked 180 executives about their level of concern about 26 topics, ranging from preparing for the Medicare Access and CHIP Reauthorization Act (MACRA) to non-merger partnership and affiliation models. Their top five concerns were: Continue reading…

New guidelines establish bone scan appropriate use criteria for prostate, breast cancer

New guidelines are out for appropriate use of bone scintigraphy, scans for bone metastases. On April 6, the Society of Nuclear Medicine & Molecular Imaging (SNMMI) published appropriate use criteria for implementation with patients who have breast or prostate cancer. The guidelines are designed to help referring physicians and other ordering professionals abide by the requirements set forth in the 2014 Protecting Access to Medicine Act (PAMA). According to the guidelines bone scintigraphy is appropriate for prostate cancer. Continue reading…



NC Today: Kathy Flood outlines the highlights of this year’s program

Posted on: 04.21.17

This year, the American Society of Nuclear Cardiology will host its 2017 NC Today: Best Practices for Today, Innovations for Tomorrow program from April 20 through April 23, 2017 at the Chicago O’Hare Hotel in Rosemont, Illinois.

“This meeting is very different from our annual meeting in that we really focus on the topics that are particularly relevant and helpful to our attendees in everyday practice. It is designed with the goal that they will be able to expand and improve what they are currently doing in practice and take some ‘aha’ moments back to their nuclear lab, and start implementing new and practical processes right away,” said Kathy Flood, CEO of ASNC.

Cardiologists, nuclear medicine physicians, nuclear technologists, radiologists, and other nuclear cardiology professionals from the U.S. and globally will join us for the highly anticipated, case-based training that will ultimately support the nuclear lab team in today’s rapidly changing healthcare environment.

Meeting highlights

Given this value-based era of healthcare, the meeting will address the need and solutions to improve the quality of SPECT and PET imaging so that nuclear cardiology is viewed as a high-value test. It will look at applications that will help manage various conditions, such as heart failure, through image-guided management and explore other strategies and novel applications that will move beyond what’s considered to be within the traditional scope of nuclear cardiology.

Another area of focus will be helping attendees navigate through the barrage of health policy issues. Are you still not sure what MACRA looks like or how your practice will work successfully under the new rules? Hear how MACRA and CV bundled payments impact imaging services and what the future of nuclear imaging looks like as a result.

ASNC, in conjunction with MedAxiom, will once again be releasing the ASNC-MEDEXCELLENCE Survey. These practice trends will serve as a resource to drive performance and create value in your practice. Attendees are able to see what needs to change in order to be in better alignment with best practice labs and ultimately operating at their highest value.

“The program will be filled with valuable education and discussion, but I think the biggest takeaway will likely be the Practical Dilemmas in Nuclear Cardiology session,” said Flood. These are the everyday questions or issues that may or may not be addressed in the guidelines. You’ll hear what the experts do in practice to tackle those not-so-easy situations that you see in your office on a regular basis.

For technologists only

If you’re a technologist attending the event, be sure to check out the pre-meeting session specifically designed to address value in your laboratory. “We want physicians and technologists to come together for this kind of education, because it takes a team to execute,” said Flood, “but we also want to offer time where they’re able to have an exchange among themselves.”

Key speakers

Past ASNC Board members Dennis A. Calnon, MD, and David A. Wolinsky, MD are co-directors of this year’s event. Among others, Jim Udelson, MD and Kim Williams, MD, Chiefs of Cardiology at their respective institutions, as well as past ASNC Presidents, will be speaking at the meeting. Both Rob Pagnanelli, CNMT and April Mann, CNMT will share their technologists’ perspective as well. Each one is an expert in their field and brings a wealth of knowledge to the program. The environment is designed to encourage questions and discussion, so don’t hesitate to join the conversation.

Come visit us!

Digirad is proud to be among the exhibitors at this year’s program so be sure to look for us in the Exhibit Hall. For more information on the program, visit the ASNC website.



A Preview of ASNC’s NC Today Conference

Posted on: 04.18.17

The American Society of Nuclear Cardiology (ASNC) will hold its highly anticipated 2017 NC Today meeting from April 20 – April 23, 2017 at the Lowe’s Chicago O’Hare Hotel in Rosemont, Illinois. The Best Practices for Today, Innovations for Tomorrow program will draw cardiologists, nuclear medicine physicians, nuclear technologists, radiologists, and other nuclear cardiology professionals from all over the world who are interested in in-depth, case-based training that will and help them lead their teams in today’s rapidly evolving healthcare environment.

Why Should I Attend?

With healthcare’s growing emphasis on value, whether it’s on how quality care will be assessed or how reimbursements will be calculated, you’ll dive into a comprehensive curriculum that combines practical learning with forward-looking discussions about increasing the value of imaging in practice.

You’ll not only gain knowledge, but also competence and improved performance in areas like reducing radiation doses and applying appropriate use criteria and guidelines. You’ll delve into the evolving role of multi-modality imaging and the technical aspects of PET imaging, and discuss the importance of data reporting and performance measures. In the end you’ll see how these topics and more are contributing to the changing healthcare environment and impacting nuclear cardiology. For more detailed descriptions of the sessions, here’s the program agenda.

Continuing Education

The program content qualifies for continuing education (CE) credit. With scheduling challenges, additional cost, and sometimes limited availability of qualifying instruction, satisfying the requirements of the regulatory world is particularly important for both technologists and physicians, especially in light of the new regulatory mandates.

ASNC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians and designates the program for a maximum of 19 AMA PRA Category 1 Credits. They are also a recognized provider of continuing education credit for technologists. Their CE credit is accepted by the NMTCB and ARRT. The program has been approved for a maximum of 19.0 ARRT Category A credits for technologists.

Visit us!

Digirad is proud to be among the exhibitors at this year’s program. Be sure to look for us in the Exhibit Hall. For more information on the program or to register, visit the ASNC website .



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