Several factors are impacting the MRI market. On one hand, providers are seeing an upswing in some studies. Breast MRI, for example, has demonstrated its utility in women with a high risk of developing breast cancer with many facilities reporting a doubling of studies since a year ago, and other scans like prostate MRI are expected to follow a similar pattern.
On the other hand, the Deficit Reduction Act of 2005 (DRA) and more stringent private insurers pre-authorization requirements are pinching MRI providers. Volume is dropping at some sites, while costs are rising at nearly all. But smart centers are deploying a variety of strategies to thrive in the current market, including:
- An emphasis on high-quality service and sub-specialty interpretations
- Carefully focused marketing to referring physicians and patients
- Focused business cost analyses
- Judicious use of staff and software
Many successful programs center on the current sweet spot in MRI scanning: 1.5 Tesla systems. These systems, many with large bores for easy patient access, offer the power of a high-field magnet with high resolution, sensitivity and established protocols to meet the clinical and financial needs of many providers. This month, Health Imaging & IT visits some successful operations to learn more about their strategies and plans for the future.
The universal magnet
MRI at Belfair in Bluffton, S.C., is a single-modality imaging center equipped with the GE Healthcare Signa HDX 1.5T Twinspeed scanner. The system is a perfect fit for the center’s needs, says President and Medical Director Joseph Borelli, MD. “There are drawbacks to 3T, particularly for single-magnet facilities,” continues Borelli. 3T can be prone to artifacts, and some scans cannot be performed on 3T systems. Cardiac imaging, scanning patients with large abdomens and breast studies can be very challenging on 3T systems because of issues like signal dropoff. 1.5T systems, on the other hand, aren’t associated with such drawbacks, says Borelli. In fact, current-generation 1.5T systems hit the sweet spot, and allow sites to offer an array of high-quality scans.
Take for example Suburban Imaging, a seven-site radiology practice in suburban Minneapolis. The group has transitioned to 1.5T magnets throughout its centers and uses nine Siemens Medical Solutions Magnetom systems, including one Magnetom Espree open scanner.
The practice reserves the open system for large or claustrophobic patients, but because it is a high-field magnet, the Espree is suitable for most studies. “The sophistication, sensitivity and resolution of 1.5T MRI meets our needs,” confirms Aaron Binstock, MD, body imaging radiologist.
The center offers a wide array of MRI studies; it has seen an increase in breast MRI volume since the March 2007 American Cancer Society recommendation that certain high-risk women receive annual breast MRI scans in addition to mammograms. Plus, MRI is helpful in patients with known breast cancer, says Nihar Shah, MD, body imaging radiologist. In addition, radiologists use MRI to characterize indeterminate findings on CT scans. It can prevent unnecessary biopsies or interventions, says Binstock.
What’s more, clinical applications continue to evolve. Functional MRI, particularly breast and prostate MRI, is poised for a clinical breakthrough. “Dynamic contrast enhanced MRI could revolutionize the diagnosis and staging of prostate cancer,” Borelli says. Recent studies point to 95 percent prostate cancer staging accuracy via dynamic contrast vs. 70 to 80 percent with MR spectroscopy. And body imaging continues to grow especially with mounting concerns about radiation exposure.
Dealing with DRA
Health Scan Imaging (HIS) in Palm Desert, Calif., operates a network of eight imaging centers in southern California. Four sites are outfitted with Toshiba America Medical Systems Vantage 1.5T MRI scanners. Like others across the nation, the practice is attempting to cope with DRA.
“It’s driven down MRI referrals and added an administrative burden on top of the 25 percent cut in Medicare payments,” sums Medical Director William Kelly, MD. In the last year, HSI has added an additional FTE at each site to handle the additional hour of pre-authorization paperwork needed for every case. That’s because referring practices need assistance to secure pre-authorization. The breakeven point on MRI went from seven to eight studies per day on a scanner