Shared cardiac PET programs can expand access while controlling costs
With cardiac positron emission tomography (PET) gaining more and more momentum as the preferred myocardial perfusion imaging modality, healthcare systems are increasingly looking at shared-service models between cardiology and radiology to make the technology financially sustainable and improve patient access.
Speaking during a business session at ACC.26, the American College of Cardiology (ACC) annual conference, earlier this year, Nicole Knight, LPN, CPC, CCS-P, executive vice president of revenue cycle solutions and care transformation at MedAxiom, said building a successful shared cardiac PET program requires careful planning around operations, reimbursement, staffing and physician collaboration—not simply purchasing an expensive PET scanner. She spoke to Cardiovascular Business in the above video interview.
"The operational and financial piece is key," Knight explained. "How do you allocate those resources? What does that look like from a business case with our payers? Who's going to interpret the studies? How do we ensure we're capturing all of the costs and supplies?"
Unlike oncology PET imaging, cardiac PET adds several workflow complexities, including pharmacologic stress testing and physician supervision requirements that radiology departments may not routinely manage. Those differences require coordination between cardiologists, radiologists, technologists and hospital administrators to maximize scanner utilization while maintaining reimbursement and regulatory compliance.
Maximizing expensive PET imaging resources
The push toward shared-service models comes as cardiac PET adoption accelerates. Earlier this year, the American Society of Nuclear Cardiology (ASNC) identified PET as the preferred modality for myocardial perfusion imaging when available, citing its superior image quality, diagnostic accuracy and lower radiation exposure compared with traditional SPECT imaging.
Access, however, remains limited because PET scanners represent a significant capital investment and historically required high patient volumes to justify the cost of rubidium-82 generators, which can cost upwards of $30,000 each month. But the introduction of unit-dose flurpiridaz F-18 (Flyrcado) has created additional flexibility for lower-volume cardiac PET programs by eliminating the need for a rubidium generator.
Knight explained that sharing scanners already used for oncology or radiology imaging can help health systems better utilize that equipment. "Particularly if you have that expensive equipment and you have idle time on that scanner, making that shared-service model work can be very successful," she said.
PET training and workflow are critical
Knight identified technologist training as one of the largest operational hurdles. Many PET technologists have extensive oncology experience, but limited exposure to cardiac imaging workflows, pharmacologic stress testing and cardiac PET radiotracers.
"The biggest piece about the shared services is their training," Knight said. "Many of the techs don't have that training, so how do you facilitate that? And then include that as an indirect cost in building these programs."
She said health systems also need to determine how pharmacy costs, stress agents and supplies are allocated between departments since those decisions directly affect reimbursement, cost reporting and long-term program sustainability.
Beyond staffing, Knight emphasized the importance of educating referring physicians about appropriate patient selection and ensuring the scanner is fully utilized.
"Sometimes we'll hear, 'My scanner's sitting idle. I'm only doing 16 a week,'" she said. "How do I optimize that and really communicate to referring providers that this technology is available?"
Early collaboration improves success of PET programs
Knight said one of the most important things organizations launching shared PET services can do is involving frontline staff from the beginning rather than relying solely on executive leadership. That includes technologists, physicians, radiology leadership, cardiology leadership and pharmacy personnel working together to design workflows before the program launches.
She also recommended identifying physician champions within both cardiology and radiology to promote adoption and educate colleagues on the need for cardiac PET.
"That champion is key to really drive that message," Knight said. "If I've been using SPECT, what does PET mean and when should I use it?"
From MedAxiom's perspective, Knight said the goal is helping health systems build operationally sound programs that improve patient access from day one.
"It's not just buying a scanner or getting rubidium or getting Flyrcado," she said. "It's about how do you operationalize it to make it successful out of the gate so you're not chasing that piece later and having failures along the way."
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]