Imaging Technology Assessment: Business and Clinical Perspectives
Mital PatelInvesting in a new piece of imaging equipment can be a daunting proposition, particularly when the equipment is in the high-tech—and high-expense—category. For imaging centers, which are facing increasing pressure to make the most of every capital investment, the challenges multiply. What are the clinical and business considerations of most importance to imaging centers, and how do they acquire the information they need to purchase with confidence? John FellerJohn RoefsMital Patel, director of West Coast business development for Truxtun Radiology Medical Group (a part of RadNet Inc), Bakersfield, California, says, “It’s very important now, with reimbursement going down, to get a return on your investment as quickly as possible—not only in terms of capital, but in terms of patient throughput. Marketability is a factor: In order to achieve that goal, we want something we can market—something that will capture a niche in the patient area.” John Feller, MD, medical director of Desert Medical Imaging, Indian Wells, California, concurs. He says, “Throughput is very important—making sure workflow is efficient so we can get enough patients through the scanner to justify it financially. The image quality has to be good enough, early on, that you can market it; later, when you’re busy as a result of that marketing, you want to be fast enough to handle that volume.” Business Considerations In January 2009, Truxtun Radiology Medical Group installed an Oasis 1.2T boreless MRI system from Hitachi Medical Systems America (Twinsburg, Ohio) in its newest imaging center. “We really had to educate the referring physicians on what the system was—the fact that it was both high field and able to provide better patient comfort,” Patel recalls. “We took images from a 1.5T scanner and the Oasis and put them next to each other without telling them which was which; they couldn’t tell the difference. That was very important to the referring physicians.” Rapidly establishing the advantages of a new scanner can be a challenge, which is why Feller agrees that marketability of a new piece of equipment is important—for both referring physicians and patients. “Demographics played a big role, as did our existing branding,” Feller says; he implemented the Oasis system in August 2010. He adds, “We’re in a retirement community. I joke that if a patient’s under 55, we need a pediatric radiologist. Our average patient is an 80–year-old person in active retirement here in the desert. These patients can have movement disorders or pain that makes it difficult for them to hold still.” For this reason, Desert Medical Imaging had already marketed its use of low-field open MRI systems, and it wanted to continue marketing patient-friendly MRI—in addition to meeting other business goals. “We didn’t want to give up our existing open branding, but we also wanted to improve image quality, so we wouldn’t have to send any patients to other centers,” Feller says. “We also wanted to accommodate all patients without losing any business to competitors because of comfort issues. We look at the Oasis as two for one: the comfort of an open MRI with the image quality of a 1.5T system.” Patel also took advantage of the Oasis system’s design to market directly to patients. “We did a television ad to show how the unit actually looks—it’s a product people need to see,” he says. “We did commercials to show everyone that it’s truly an open MRI. We’ve had patients go to our competitors who claim to have an open system, but really just have a wide-bore system; when they walk in, they recognize it’s not open and wind up rescheduling with us.” Both facilities have been satisfied with the throughput that they have been able to achieve with the new equipment. Desert Medical Imaging now performs 16 to 20 MRI studies a day, versus the 12 to 13 that it was averaging on its low-field open scanner, and Truxtun Radiology Medical Group has increased its throughput from 18 to 20 patients a day to 22 to 24. “We were able to grow our business very quickly based on the higher throughput,” Feller says. Clinical Needs John Roefs, MD, of Truxtun Radiology Medical Group, notes that evaluating the images produced by a new scanner can be one of the most difficult aspects of the technology-assessment process. “It’s very important to find another facility that has the equipment in use, if you can, so you can actually see the images the unit produces in real life,” he notes. “There are studies that tax the system more, such as temperomandibular joint studies or MR angiography (MRA); those are good studies to use to assess the capabilities of the machine.” Feller agrees; he has a slate of exams that he calls the litmus test for evaluating the capabilities of a new MRI system. “I want to see image quality on axial cervical spine images and what an MRA of the brain looks like, and I want to know something about the temporal resolution—what a dynamic, contrast-enhanced breast study or angiogram will look like. Based on 20 years of experience, I know that if there are weaknesses in a scanner or platform, these exams will bring them out,” he says. Feller adds that it was important to his team to acquire a scanner that could do more than bread-and-butter MRI exams, in part because of Desert Medical Imaging’s previous positioning. “We pride ourselves on being a full-service MRI center,” he says. “We want to be able to do everything. We need the scanner to be everything to everyone; unlike the old low-field open scanners, where you used to have to triage certain types of exams, in 2011, any platform we invest in needs to be able to handle all types of patients.” For Roefs, the addition of a high-field boreless scanner to Truxtun Radiology Medical Group’s armamentarium also meant the ability to accommodate more patients. “Image quality and resolution are our top clinical priorities in choosing an MRI, which is why the magnet we selected was perfect,” he says. “Downtown, we plan to implement a 3T magnet, and between the two, we should be able to cover all of our patients.” Feller concludes by observing that a thorough, comprehensive assessment of new technology is increasingly critical for imaging centers. He says, “As the margins in outpatient imaging become narrower and narrower, it’s becoming more and more important to select appropriate equipment—and more and more effort should be put into analyzing how people will satisfy their equipment needs. We don’t have a complicated hospital budget, so when I select things, I’m very value driven. We want to make sure we get the most bang for our buck.” Cat Vasko is editor of and associate editor of Radiology Business Journal.