Mitigating the Impact of DRA: Lessons from the Field
St. Vincent’s PET Center has provided PET/CT services since 2004. The center managed to turn a reasonable profit prior to the enactment of the Deficit Reduction Act (DRA) in January 2007. As many facilities have realized, the DRA changes the reimbursement environment and makes it difficult for PET centers to remain profitable; thus increasing the likelihood of making PET/CT unavailable for Medicare recipients.

The DRA creates a precarious operating environment for PET imaging centers, but there are ways to lessen its effect until these cuts can be mitigated. One way to help minimize the negative impact of the DRA is participation in the National Oncology PET Registry (NOPR – www.cancer.petregistry.org).

The NOPR is a collaborative effort among the American College of Radiology Imaging Network (ACRIN), the American College of Radiology (ACR) and the Academy of Molecular Imaging (AMI). The purpose of NOPR is to determine the clinical utility of PET for indications beyond those currently approved for Medicare reimbursement. This opens the PET market to include cancers and indications not presently eligible for Medicare reimbursement. For example, as an NOPR participant, St. Vincent’s PET Center can obtain reimbursement on PET scans for conditionally covered indications such as prostate, bladder and ovarian cancers. NOPR participants agree to provide the registry with complete and timely data about intended patient management. In return, the Centers for Medicare and Medicaid Services (CMS) reimburse the facility and interpreting physician for the scan. 

The registry benefits PET centers in both the short and long term. In the short term, it lessens the impact of the DRA. In the long term, it could lead to expanded coverage if the data demonstrate the positive impact of PET and PET/CT on patient management.


NOPR: The financial impact
NOPR can drive a new patient influx — which is especially critical for centers with high Medicare-eligible patient populations because the DRA slashed Medicare reimbursement for PET/CT scans by more than 54 percent. The immediate result was to transform St. Vincent’s PET Center from a profitable organization into one that barely breaks even.

NOPR can help St. Vincent’s PET Center maintain a steady patient flow at the volume necessary to remain financially viable. NOPR registration is straightforward, and as an NOPR-registered site, St. Vincent’s PET Center can market its services to a wider population of referring physicians. For example, since registering as an NOPR site in May 2006, St. Vincent’s PET Center has shared information about the NOPR and PET scanning with ob-gyns, urologists and internal medicine physicians. The referring physician can learn about the process from the NOPR website or call St. Vincent’s PET Center with additional questions (205-930-2670); most questions are easily answered. NOPR streamlines the reimbursement process for the PET center by communicating with the PET Center electronically about entering and reporting patient data.


NOPR: Before and after
Prior to registering as an NOPR site, St. Vincent’s PET Center performed scans on Medicare-approved indications only, which excluded certain cancers. NOPR aims to collect data to determine the utility of PET in broader applications including the diagnosis, initial staging, treatment monitoring and restaging for virtually all cancers. In fact, prostate cancer and ovarian cancer seem to be an operational success. Since registering as an NOPR site, St. Vincent’s PET center has realized its most significant patient gain in prostate and ovarian cancer scanning. 

The reason behind the patient gain is marketing and physician education. St. Vincent’s PET Center has educated area urologists and oncologists about NOPR and the potential benefits of PET scanning. The result is an influx of new cancer patients who would not have been PET scan candidates prior to registry as an NOPR site.


DRA and NOPR
The DRA regulations have been extremely detrimental to PET centers from a financial perspective. NOPR helps take some of the bite out of the DRA and could help set the stage for expanded PET reimbursement in the future.

Robert Wynn, BS, CNM, is PET/CT Center Director at St. Vincent’s PET Center in Birmingham, Ala.


ADDITIONAL RESOURCES
View a list of cancers and indications eligible for entry in the NOPR