Cardiovascular CT is profitable -- for cardiologists

Cardiologists can make money owning CT scanners and performing coronary CT angiography, according to a presentation given at the North American Society for Cardiac Imaging meeting this week in Amelia Island, FL.

Timothy Attebery, CEO of South Carolina Heart Center in Columbia, oversees 29 cardiologists in 23 locations. Income from the groups' coronary CTA scans has risen from $200,000 in 2002 to a projected annualized income of $600,000 this year and $1 million in 2005.

"We are getting paid," Attebery said.

The cardiologists at South Carolina Heart own the machines and control all of the CT activities. They have contracted with the main radiology group in town to provide exclusive overread services. Attebery emphasized that he did not ask the radiologists for permission to perform coronary CTA.

"We told them we were getting into the CT business and offered them a plan to cooperate," he said.

Attebery estimated it takes about $4000 per day to break even on the technical fee. But groups also should consider if a CT scanner will add to physician efficiency. The number of angiographies a cardiologist can get done working from one lab is fixed. Part of the challenge is expanding that volume without requiring more physician time. Cornary CTA is efficient, he said.

Based on the group's early work with calcium scoring and the current CTA studies, Attebery concluded that CTA adds unique clinical value. It provides real information that nuclear imaging, echocardiography, or even conventional catheter angiography would not have provided, and it does so at a lower cost and increased convenience for patients. The group currently performs five to eight CTAs daily and expects to do 15 per day by the end of 2005.

The growing threat that the Centers for Medicare and Medicaid Services will reduce reimbursement for nuclear perfusion scans is another reason to incorporate CTA.

"About 30% of a cardiologist's income is from CPT code 78465, and that code is in the bull's-eye of CMS," Attebery said. "We cannot rely upon that income stream forever. We look at CT as the next frontier of imaging."

Cardiovascular CT is an open canvas, and everybody will have a different view for its use, he said. It's important to have consensus about the clinical role CT will play. Otherwise a group will have difficulty persuading local payers to reimburse for the procedure.

Attebery armed himself with supportive data and convinced his local Medicare medical director that coronary CTA exams are beneficial and cost-effective. He then helped write payment guidelines for the entire state of South Carolina. The CPT and ICD-9 coding rules were published in July, and the group is getting paid by all the major payers for coronary CTA.

He suggests being very specific with payers, letting them know when you are going to use CTA, why you are going to use it, and why it has value.

"We would never have gotten paid from any third-party payer if we had asked permission to buy a machine," Attebery said. "If you go and ask them to pay you and they say no, you'll think you were smart to ask first. But you'll never get paid if you ask them. You have to take a clinical leap of faith and talk to payers with supportive clinical arguments."

South Carolina Heart's CT evolution began with the purchase of a two-slice scanner in 2000. The first in its market to offer coronary CTA, the group decided against investing in an MR or PET scanner because it considered CT in the cardiovascular setting "less cannabalizing" of its business.

The group also decided against purchasing an electron-beam CT scanner, concluding that EBCT had reached a certain point of evolution and was not capable of moving to a higher level. It recently purchased a 16-slice scanner and will obtain a 64-slice machine by year's end.

Regarding placement of the CT scanner, Attebery said it should be located as close as possible to where cardiovascular patients come for service. The scanner will not reach the high level of utilization possible if it is located in a free-standing center or nondisease management location.

Many strategic forces are coming together for cardiology, including advances in technology and an emphasis on disease management and prevention. Whoever has the capacity to treat more patients will win the game, Attebery said.

"Cardiovascular CT and other noninvasive techniques that we're looking at are designed to help us take care of a growing number of patients. And with the baby boomers, we will have a growing demand for services," he said.

For more information from the Diagnostic Imaging archives:

Radiologists, say goodbye to cardiac CT

CT and MR gain ground in plaque detection

Early adopters express high praise for new multislice CTs

Multislice CT challenges MR in plaque detection