How to leverage mobile imaging when facing a natural disasterPosted on: 09.06.18
In times of disaster, the demand for immediate emergency healthcare services can quickly surpass an area’s capacity. Most disasters are localized, and residents who are sick or injured depend on the care, services, and expertise provided by the local hospital. It’s critical for the hospital system to have an effective recovery and management plan in place.
Here are some considerations for designing a comprehensive, multi-faceted, and scenario-driven approach to disaster response:
Disasters are unpredictable
In the aftermath of a disaster, patients in need of care will instinctively head to the nearest hospital. Most disaster recovery plans address preparation for the onslaught of emergencies, overcrowding, and insufficient personnel. But, you also need to plan for the possibility that the facility may be unreachable for some. Roads may be impassable due to flooding, landslides, or debris. Transportation services may be limited, or the hospital itself may be damaged or inoperable.
How to prepare for the worst
Under any conditions, hospitals need to be resilient. They need to be able to absorb and respond to the shock of a disaster, continue to provide critical functionality and work quickly to recover to their original state. Sometimes that may require the help of an outside organization who can fill the gaps and bring imaging and emergency clinical services to the community.
A well-designed recovery plan should most certainly consider partnering with a mobile health care provider that, when necessary, can respond quickly and arrive at any location with the critical staff, supplies, and equipment.
In preparation, it’s important to research your vendors. Before the emergency you should use due diligence to identify providers who are reputable and have the appropriate credentials like ISO 9000 accreditation and the Joint Commission (JCAHO) certification. They’ll have the policies and procedures already in place and have the support structure, too. In doing so, you’ll ensure the same high quality of care for your patients, regardless of who administers it.
How will service be delivered?
A mobile healthcare unit is comprised of a fully equipped, furnished, tractor-trailer with onboard equipment powered by a generator. It can be parked at almost any location that has a flat surface. Asphalt is ideal because its surface is firm and level, but tightly packed gravel is an option in certain cases.
Once it’s delivered to the designated site, the staff will set up the equipment and establish the electrical and internet connections. These mobile units can provide CT, MRI and Ultrasound imaging as well as acting as a freestanding medical clinic.
The mobile healthcare company can provide a team of fully functional personnel to operate the unit, but their personnel can also provide on-site ad hoc equipment training to your staff in order to provide a continuum of care.
What information will we need to provide?
During a disaster, the following information can help decrease response time and significantly increase a mobile unit’s preparedness.
1. Network information
Providing network information in advance of arrival allows the unit to establish a connection as quickly as possible and minimize start-up time.
2. Identification of an alternative site, as needed
Potential alternative sites should be identified well in advance of any disaster, if possible. Whether it’s an empty parking lot, a football field, or any other location, permissions should be in place prior to the mobile unit’s arrival. It’s also helpful if on-site power is identified, rather than relying on the onboard generator.
It’s important to have an accurate count of your available staff and be able to communicate your additional personnel needs. Upon the unit’s arrival, there should be a key staff member who can take charge of the unit and give direction to the team.
4. Resolution of specific state regulation conflicts
Any specific state regulations that can complicate delivery of services should be identified in advance. For example, some mobile healthcare companies may not be registered in all states, and special prior approval may be needed.
Planning is not a prerequisite
While partnering with a mobile healthcare company in advance is the best approach to managing any disaster scenario, it’s not a prerequisite. Mobile healthcare companies can often respond on-demand and together you can still create a customized plan as you go.
The most important thing is that people receive the necessary medical attention and can trust their local hospital to continue to provide the highest level of quality care, even in the face of disaster.
Medicare PET/CT Reimbursement for Oncology: What’s covered, what’s notPosted on: 08.16.18
PET/CT is a vital diagnostic imaging tool and is especially effective in revealing conditions such as cancer and brain disorders. When it comes to Medicare coverage, there are a number of misconceptions about PET/CT reimbursements.
In the majority of cases, PET/CT imaging is covered when clinically necessary, either as an initial treatment strategy or a subsequent treatment strategy.
Few exceptions apply to specific breast and cervical cancer, and melanoma diagnoses. The initial treatment of prostate cancer is the only non-covered event. Below is a consolidated reference chart that details PET/CT insurance reimbursement for specific conditions.
|Tumor Type||Initial Treatment Strategy||Subsequent Treatment Strategy|
|Breast Cancer (female & male)||*CWE||✓|
|Head & Neck Cancer (not thyroid or CNS)||✓||✓|
|Non-Small Cell Lung Cancer||✓||✓|
|Small Cell Lung Cancer||✓||✓|
|Soft Tissue Sarcoma||✓||✓|
|All other solid tumors||✓||✓|
|All other cancers not listed||✓||✓|
*CWE = Covered w/ exceptions
Cervical: Nationally non-covered for the diagnosis of cervical cancer related to initial anti-tumor treatment strategy. All other indications for initial anti-tumor treatment strategy for cervical cancer are nationally covered.
Breast: Nationally non-covered for initial diagnosis and/or initial staging of axillary lymph nodes. Nationally covered for initial staging of metastatic disease. All other indications for initial anti-tumor treatment strategy for breast cancer are nationally covered.
Melanoma: Non-covered for initial staging of regional lymph nodes. All other indications for initial anti-tumor treatment strategy for melanoma are nationally covered.
Leukemia: Nationally covered under “all other cancers not listed.”
Prostate cancer (dx 185.0) is not covered for initial treatment strategy. Therefore, all PI modifiers for 185.0 would be denied and PS modifiers would follow the same frequency as other cancer diagnosis codes.
Why you should rethink PET/CT imaging for prostate cancerPosted on: 06.28.18
The large majority of the nuclear imaging community would be quick to point out that PET/CT imaging with either 18Fluorodeoxyglucose (18FDG), or Sodium 18Fluoride (NaF18), is not effective in prostate cancer diagnosis. In fact, it’s not even approved for initial prostate treatment strategy.
With oncology imaging, most other cancers are green-lighted for both initial and subsequent treatment strategies. Prostate imaging, however, is only approved in the latter.
Radiopharmaceuticals and diagnosis
Because prostate cancer is a slow growing, less aggressive disease, the common sugar-based FDG is not an effective agent for diagnosis, but it can be used appropriately to identify metastasis in the body during subsequent treatment.
Sodium 18Fluoride (NaF18), has been used in bone imaging and was previously covered through the National Oncologic Pet Registry (NOPR). However, when the radiopharmaceutical reimbursement was discontinued in December 2017, it lost some of its popularity among physicians. Based on the NOPR study results, coverage is expected to be addressed in the future.
While prostate cancer is consistently one of the top three cancers in the nation, there are very few effective imaging solutions. Blood work, specifically through monitoring the prostate-specific antigen (PSA) level, delivers the majority of diagnoses. Any deviation from normal is an indicator, and may lead to surgery, cryotherapy, or radiation, as necessary.
One new radiopharmaceutical, two benefits
The relative newcomer to prostate cancer detection is Axumin (18F-Fluciclovine), which is indicated for PET imaging in men with suspected prostate cancer recurrence based on elevated PSA levels following prior treatment (chemical recurrence). By continuously monitoring PSA levels following treatment, Axumin can be used as soon as PSA levels begin trending upward leading to quicker detection.
Other imaging methods rely on physical changes in the body, whereas Axumin detects changes on the physiological level, which can develop weeks, even months earlier than physical changes. It ultimately presents a huge opportunity to fill the void in prostate imaging solutions.
An Axumin PET scan accurately identifies the cellular activity and location of a reoccurrence. While 18FDG is ideal for soft tissue, and NaF18 for bone imaging, Axumin offers the best of both worlds. Imaging studies show skeletal mass and metastasis throughout the body, including the prostate bed. When using Axumin, the imaging process begins right away and there is little to no bladder uptake visualized, whereas the traditional method of imaging with 18FDG typically has a great deal of bladder uptake. This bladder uptake, in some cases, obscures residual prostate cancer that may be in the prostate bed or regional lymph nodes.
The challenge with Axumin is its availability. It is currently available from only a handful of radiopharmacies throughout the U.S. and is only produced on certain days, with doses available during a short window of time. However, additional manufacturing sites are planned for 2018.