During the late 1990s and 2000s, many practices chose to purchase a cardiac camera. Reimbursement rates were consistent, testing volumes were high, and from both a patient care and an economic perspective, it made sense to invest in the equipment.
Shortly thereafter, a series of changes in the industry made ownership more challenging. Major insurance companies instituted a cut in nuclear cardiology reimbursements, payers implemented strict imaging pre-authorization requirements, and additional accreditations became required to operate a nuclear lab.
These shifts in the market have made ownership more challenging for physicians that still own their nuclear camera. While many practices may no longer have a loan left on their camera, they still have costs associated with its use, including the licensing, physics consultation, monthly maintenance, isotopes, consumables, and the technologists. The question many doctors have is “What do I do now?”
How are physicians addressing the problem?
Physicians have turned to a number of approaches to address the problem of increased costs and reduced reimbursements. These approaches include:
Staff Changes: Reducing the number of technologists is the obvious and first choice for physicians looking to reduce costs. If you’re seeing a drop in imaging volume, it only makes sense to have the staffing choices be based on that number.
Reduce Imaging Days: If you have a camera sitting in the office it may seem like offering imaging every day makes sense, but that decision can easily drive up costs. Bundling patients and scheduling them for specific days is a way to increase efficiency. Making this move can allow you to make your technologists part-time and keep the existing team vs. letting parts of the team go. Only paying for one or two days a week is much more cost effective if volumes are down.
Negotiating Lower Rates: Some practices have had success with negotiating lower rates on isotopes, consumables, and supplies. Additionally, the cost of the physicist and audits is negotiable so that can be an area to explore. The limiting factor with this method is leverage. Smaller practices that purchase a limited amount of supplies will not get the discount that larger practices may receive.
Partial Outsourcing: Many physicians are turning to outsourcing and bringing in outside vendors to provide elements of the service, particularly around staffing. By not having the full-time employee obligations they can easily scale their expenses to match volume. The quality and the consistency of the technologists are critical here because the team is a reflection of the practice when they’re imaging patients.
The Benefits of Comprehensive Outsourcing
Comprehensive outsourcing is a bigger decision, but it’s one that could result in the greatest cost savings. Under a comprehensive outsourcing arrangement, the outsourcing provider delivers the staff, consumables, accreditation, radiation materials license, etc. Patients are imaged at your office, but the financial burden of operating the nuclear lab is on the outsourcing partner, not your practice. Financially this works because the provider is paid a percentage of the reimbursement, so the upside is much clearer. Image and you earn a profit, don’t image and there is no penalty.
Programs such as Digirad Select provide a nuclear medicine technologist or cardiac stress technician that handles the imaging in your office, with your existing camera. Other package options include equipment, licensing, supplies, pre-authorizations, repair and maintenance, and accreditation.
Comprehensive outsourcing providers, like Digirad, are able to make the numbers work largely due to leverage. By working with thousands of practices across the country, the rates they are charged are lower, and this creates efficiencies that lower costs and increase the quality of the service.
Regardless of the options you choose to implement, it’s important to stay ahead of trends in both technology and the reimbursement landscape. Managing your overhead will protect your ability to help future patients as the market evolves.
