We see it everywhere—news about slowdowns in imaging equipment purchases, reductions in reimbursement and the overall poor economic climate. But the demand is steady for breast and cardiac MR, and many facilities across the United States are seeing minimal impact on purchasing needs in the desire to provide leading-edge, quality care.
It’s a fact—the medical imaging community is still feeling ripple effects from the Deficit Reduction Act (DRA) of 2005. IMV Medical Information Division reported last year that MRI procedure growth in the United States has slowed, to approximately a 3 percent annual growth rate, compared to the beginning of the decade. In 2007, an estimated 27.5 million procedures were performed within about 7,200 sites, compared to 24.2 million in 2003, due in part to pre-certification requirements by payors and the maturity of the MRI market.
However, new and niche studies are still a key growth area within MRI—approximately 20 percent of facilities planning an MRI purchase over the next few years are planning to purchase systems as replacement or additional units for their departments (according to IMV)—a fact supported by Centennial Medical Center in Nashville, Tenn., who purchased an additional MRI scanner in December 2008 to better position itself to expand its MRI service line.
Expanding service lines
At the end of 2008, after six to eight months of waiting and planning, Centennial Medical Center in Nashville, Tenn., opened its Christmas gift—a Magnetom Espree 1.5T open-bore MRI system from Siemens Healthcare. The 665-bed facility, which does about 140,000 imaging exams annually, had two specific goals in mind when considering adding an MRI to its imaging armamentarium: one was its desire to open a new cardiac MRI service line and the other was to offer its patient base the option of an open-bore scanner. Siemens’ Espree offered them one scanner that could meet both needs.
Many might question the business sense behind expanding a service line in light of a declining economic climate, however Kim Duncan, RBS, RT (R), says that the decision was driven by demand. “Every decision has an impact in today’s economic climate and while our push was to branch out and offer a new service, we made sure we had the demand to back it up,” Duncan says. Aside from the demand for cardiac MR angiography (MRA), the facility was getting high demand for an open bore, which was not available in its inpatient division. They were approached by one of their cardiology groups that said the patient base was there—they just had to supply the technology. Duncan says they analyzed the group’s patient volume, the need for that service in their area as well as the reimbursement for such services prior to committing to a new purchase.
Now, Centennial is the only area hospital using an open MRI of this kind on both an inpatient and outpatient basis. The new scanner can accommodate patients weighing up to 550 pounds, and with a 2.3-foot diameter bore, it minimizes the feelings of confinement and claustrophobia for most patients.
While exam growth is still in its infancy for cardiac MRAs—they are doing approximately three to five about three days per week—the expectation is high for the need for studies to extend beyond the cardiology group to other physicians, says Kay Lynn, RT, (R)(M), manager of MR and CT. Additionally, since it is not a dedicated cardiac MR scanner, volume has picked up in other areas for patients who require the open-bore design. In one instance, it eliminated the need and cost for the presence of an anesthesiologist for a patient who had suffered caustrophobia in the past who was able to be scanned without sedation.
Although the system is not dedicated for cardiac studies, there are dedicated time slots for cardiac MRA put on the schedule each week, and for any bariatric patient or patient who would benefit from the open bore, he or she is scheduled on that scanner. “We work closely with the scheduling department to minimize the potential for bottlenecks,” Duncan says, who adds that report turn-around time at Centennial—from sign-in to signed report—is between two to four hours about 75 percent of the time.
Duncan and Lynn say that Centennial, which operates in the competitive Nashville market, is always looking toward the future. One avenue they are evaluating