ASNC Feature: iPod-like ultrasound systems could adversely affect echo lab dollars
PHILADELPHIA—Pocket-sized ultrasound machines have the potential to be a disruptive technology for cardiologists by reducing echo lab volumes in an era where echo reimbursement has already been substantially cut, said Alfred A. Bove, MD, PhD, a professor of medicine emeritus at Temple University School of Medicine in Philadelphia, in an interview.

Bove had briefly mentioned the impact of handheld ultrasound machines during a lecture on imaging in heart failure at the 2010 annual meeting of the American Society of Nuclear Cardiology (ASNC). He later spoke with Cardiovascular Business News about the tiny disruptive technology.

He said that such machines can help with the management of heart failure patients, in the office or at the bedside. The problem is that there is no formal reimbursement methodology established for using this echo technology when the clinician only wants a cursory look at the patient's heart.

"These handheld ultrasound machines threaten the entire echo structure, because if exams can be done at the bedside on an ad hoc basis, no one will want to pay for an echo done in the lab," he said. "This technology raises some interesting questions, but it also becomes a very important tool if we want to do a quick assessment of left ventricular function at the bedside."

There are several manufacturers that offer these tiny ultrasound machines, the latest being GE Healthcare's Vscan, which costs about $8,000 and weighs less than a pound. Bove sees a use for this technology in the emergency department (ED), but said the manufacturer is focusing on primary care physicians.

"If the primary care world grows, and I'm not sure it will, the question then is how will this technology fit into it. If primary care physicians can't get reimbursed for it, it won't catch on," Bove said.

Nevertheless, if they are used in primary care or even by hospitalists at the bedside, a quick scan can put a physician's suspicions to rest. A full echo workup would not then be necessary. Added to the potential reduction in echo lab volumes are the substantial reimbursement cuts to echo enacted over the last several years, with even more reductions to be phased in over a period of two to three years.

In order to get reimbursed for a test on these handheld machines, the clinician has to follow certain protocols. They include acquiring certain views, archiving the images in a stored image database and creating a formal report. "If you do that with these small machines, they are no longer time-savers. It would be better at that point for the tech to go to the bedside and perform a regular echo," Bove said.

Even though the screen is small, the data from 2D and color Doppler echo scans are adequate for bedside diagnoses, he said. "People who have used them have had reasonably good luck for assessment of cardiac function."

While they cost substantially less than a laptop-sized machine (around $50,000) and a full-sized model (around $250,000), not everyone will immediately invest in them, Bove said. "Its value is for a quick look at something, definitely in the ED and perhaps by cardiologists in certain areas like heart failure."

Interestingly, cardiologists who have used these tiny scanners see an opportunity to build a stethoscope head onto the probe to acquire sound and images at the same time, Bove said. "The way technology advances, we're going to see that," he said. In addition, there are electronic stethoscopes into which one could attach the probe, while the clinician puts a box that receives the data into a coat pocket or on a belt. "The whole concept of how we get paid for imaging will be challenged in that setting."

While this technology could be disruptive in today's fee-for-service reimbursement model, it would fit in nicely with a model where payment is bundled into the continuum of care. "In that model, having a big quarter-of-a-million-dollar echo machine in an imaging lab with three techs and other technology doesn't make much sense. The fate of this handheld ultrasound technology depends, to some extent, on how the reimbursement model will evolve over the next couple of years," Bove said.