Is PET Imaging in Your Future?

Thursday, September 13, 2018 | Pat White

If we don?t participate in lowering the cost, CMS and commercial payors will simply continue to reduce reimbursement.

I attended the annual meeting of the American Society of Nuclear Cardiology (ASNC) in San Francisco last week. Yes, Mark Twain was accurate when he said, “The coldest winter I ever spent was a summer in San Francisco.” People were wearing stocking caps!

Inside . . . the meeting was full of great scientific and clinical topics, including a number of presentations on Positron Emission Tomography (PET) imaging. While I am not a physician and my knowledge of nuclear physics is limited, I was impressed with the evolution of PET imaging that was evident. For example, several physicians commented on the benefits of PET related to measuring Myocardial Blood Flow (MBF):

  • Reduces unnecessary referrals to the cath lab due to the PET MBF results that indicated the patient would not benefit from an intervention.
  • Increases appropriate interventions in patients with multi-vessel disease when using PET MBF, whereas SPECT was unable to detect such balanced ischemia.

So, why aren’t more groups utilizing PET? Let me count the ways! Expensive equipment, expensive Rubidium generators/ammonia cyclotrons and questionable insurance coverage top the list of issues. But those can be addressed with a focused business plan. And if the numbers don’t work because of low volume or being risk averse, consider a turnkey solution where the turnkey partner assumes the risk, albeit with less profitability to your program. We have several Corporate Partners in that space, including some with mobile solutions.

But it’s more than that. I think inertia plays a role. If a physician was trained on SPECT, it’s probably difficult to transition some patients to a modality with which he/she has little knowledge. Education is the key. I hope your noninvasive leaders have a good handle on the technology.

I was on a panel at the ASNC meeting that included prominent PET physicians, a Ph.D. physicist, a nurse and a technologist. We shared our thoughts on how an organization might approach beginning a PET program. ASNC recorded the session and it should be available for viewing soon. Check it out and see if PET is in your future!

There are a number of studies that compare the Sensitivity/Specificity and Positive Predictive Value/Negative Predictive Value of PET. But we don’t yet have solid research to prove the cost effectiveness of PET vs. other modalities (SPECT, stress echo, CT), only anecdotal evidence. In a world where value is now valued, it seems that we need technologies/solutions such as PET with MBF to help us lower the cost of healthcare. Remember, if we don’t participate in lowering the cost, CMS and commercial payors will simply continue to reduce reimbursement. Medicare doesn’t have enough money to fund healthcare as it stands. Something has to give. As always, I am interested in hearing your perspective.

MedAxiom’s blog post is published every Thursday at



Illustration: Lee Sauer


About the Author

Pat White, MPH, Senior Advisor of MedAxiom, is a trusted cardiovascular healthcare leader and statesman. Pat has been in the healthcare management field for over 40 years. Prior to joining MedAxiom, Pat was in medical group practice management for 17 years. He spent 13 years with the Henry Ford Health System, including five years as the Administrator for the Department of Internal Medicine. He also served as the Executive Director of Michigan Heart, a 36-member cardiology practice in Ann Arbor.

Pat does senior consulting work and currently serves on the board of the Cardiology Advocacy Alliance.

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