Cardiac CT in the Outpatient Setting: Ocean Radiology

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When outpatient imaging center Ocean Radiology (New York, New York) opened its doors in South Brooklyn, seven years ago, the intention of Steven Polk, founder and owner, was to offer an unparalleled imaging service to the community. “We differentiated ourselves from the other imaging providers in the area by going with high-end equipment (which wasn’t common, around here) and with sophisticated studies that weren’t being done at the time,” Polk recalls. “The nearest hospital is an hour’s trip away, and having a study done there could take all day. We’re close to our patients’ homes, convenient, fast, and high quality.” Among the studies offered by Ocean Radiology that aren’t commonly performed in outpatient settings are coronary and vascular CT exams. Polk explains that the imaging center started performing these studies after acquiring a 64-slice CT system in 2007. “We installed the technology and discovered the demand for these studies afterward,” he says. “In our community, as in many communities, we see a lot of coronary disease and vascular disease. We do these CT studies on three to five patients a day, now. They are a big contributor to the business.” The coronary and vascular CT component of the business grew quickly—so quickly that earlier this year, Polk replaced his legacy CT system with a 64-slice Scenaria system from Hitachi Medical Systems America. “Hitachi had a product that satisfied our needs,” Polk says. “The price point was very reasonable, and in performance terms, it was more than capable of doing what we needed. Compared to our prior 64-slice CT, the Scenaria had updated computerized features that make tailoring the protocol to each patient easier and ensure the clearest results.” Patient Convenience and Satisfaction Polk knew that his patient community faced specific challenges, when it came to advanced cardiac imaging. In addition to the difficulty of reaching the nearest hospital, he notes, “We’re in a Russian-speaking market, which makes us unique. This is a densely populated area, with a lot of elderly people. We found out that their physicians were sending them to hospitals—and for these elderly, Russian-speaking people, in addition to the trouble of getting there, there’s a language barrier. It can make imaging even more traumatic and uncomfortable for them.” As evidence began to mount that cardiac CT was as good as (if not better than) a stress test in determining the cause of chest pain, Polk saw an opportunity to serve these patients better. “We believe that coronary CT is much more informative and diagnostic than stress tests, and we’ve seen the knowledge of that increasing among the cardiologists in our community,” he says. “The level of radiation delivered to the patient decreases, and the accuracy of the test increases.” Polk’s staff members work hard to keep patients comfortable and informed, and they have the ability to communicate with them in Russian, as necessary. “When patients come in, they can be very anxious,” he notes. “They don’t know what this exam is, they’ve never had it done before, and the results can be life changing for them. We let them know that it’s going to be fast and easy. All they have to do is lie down and relax for five minutes; afterward, they can get up, get dressed, walk out of here, and resume their normal activities.” Outpatient Considerations Performing these kinds of advanced studies in the outpatient setting requires the presence of a nurse and a physician—two categories of staff not commonly seen by imaging-center patients. “Having them on-site helps make the study go faster,” Polk says. “Sometimes, you need to administer beta-blockers to the patient, and you really need a physician and a nurse at hand to do that.” Even with the additional staff members, Polk finds that cardiac CT is worth the trouble: “It’s still profitable. It’s still a big part of our business,” he says. The addition of these staff members means that Ocean Radiology is able to decrease the amount of time that patients need to spend getting their studies drastically, Polk notes. “The scan itself is not that long or complicated; it takes about five minutes,” he says. “It’s the preparation that can take a long time: interviewing patients, getting them on the table, putting in IVs, assessing whether they need medication, and just talking to them and preparing them for the study. We get it done as fast as we can.” As a result, the turnaround time for patients is under half an hour, Polk says. “It’s a lot more convenient for patients to come here and get the studies done in a very short, comfortable time,” he says. “It’s a big advantage for them.” The outpatient setting is also more affordable for patients without insurance. Polk adds, “They get charged more in the hospital setting, and they know that.” Going forward, Polk expects this segment of his center’s business to increase, both because of clinical trends and because of patient convenience. “We hope we will see a shift from routinely doing stress tests to cardiac CT,” he says. “We’ve observed a big demand for these studies, in this setting, from referring physicians and patients alike.” Cat Vasko is editor of and associate editor of Radiology Business Journal.