Hub-and-spoke model expands access to CCTA as the modality continues to gain momentum

Coords currently works across 11 markets and has implemented this specific model at more than 100 locations over the years years. He thinks a major advantage of this approach is the ability to centralize functions that otherwise might have to be duplicated at every location. Scheduling, billing, reimbursement, authorization and other administrative processes can be managed by teams with specialized expertise, allowing performance to be monitored across multiple markets.

He said this can also make it easier to identify problems. If one location or market is generating less reimbursement than another, for example, centralized oversight can help determine whether the issue involves billing practices, documentation, payer policies or another part of the workflow.

Hub-and-spoke models also help community hospitals and imaging centers overcome one of their biggest barriers to adopting CCTA: the lack of experienced cardiac imaging personnel.

Facilities may already have CT scanners and technologists capable of performing examinations, but lack specialized cardiac readers or technologists experienced with cardiac CT protocols. Under a hub-and-spoke structure, local technologists can receive training, while remote specialists provide additional support.

“We'll train your local technologist, but you will have remote support who can access the scanner, who can make sure the scan's being performed correctly,” Coords said.

The model can be particularly useful as demand for cardiac CT grows across emergency, inpatient and outpatient settings. Rather than requiring each facility to build a complete cardiac imaging operation, health systems can leverage a centralized team and infrastructure across multiple locations.

For Coords, the biggest lesson is that successful CCTA expansion requires attention to the business side of the operation as well as clinical quality.

A centralized model can reduce overhead by avoiding the need to replicate specialized staff and processes at every site. It can also provide greater consistency in turnaround times, protocols and quality control.

One area that deserves particular attention is reimbursement. Coords recommends organizations routinely review reimbursement performance and identify payers or locations where expected payment is not being received.

“When it comes to CCTA, FFR-CT and plaque analysis, almost all the payers are reimbursing for it,” he said. “What you need to identify is, if you're not getting reimbursement, why?”

Problems can stem from bundled services, billing practices or inadequate documentation rather than a fundamental lack of coverage, he said. Identifying those issues early can help organizations recover appropriate reimbursement and prevent recurring revenue losses.

Ultimately, Coords said, the hub-and-spoke model provides a way to scale CCTA without simply replicating the same infrastructure at every facility.

“It’s not just about scanning,” he said. “You need to have everything come together.”