Dr. O'Donnell also points out that even though small facilities suffered from the SPECT reimbursement drop, change over to PET is not a given.

"I straddle the cardiology world as well. The office-based cardiology practices have taken a terrific financial hit this year from Medicare and CMS with reimbursement," says Dr. O'Donnell. "Some are looking into getting into PET, but it's not a small investment. You never know if Medicare is going to hammer PET next year," he says.


Health Care Law on Imaging

There was a lot of confusion about the health care bill before it passed. Now that it is law, much of the mystery about its lengthy contents still remains.

"Even though the health care reform act has passed, a lot of our customers, as well as manufacturers like Philips, are still digesting what that's going to mean. Are manufacturers going to be paying excise taxes on medical devices? What do new utilization rates mean to our customers and what's going to happen to reimbursement rates in the next couple of years? There are still a lot of unanswered questions," says Smith. "Our customers are starting to study what that means to them and to the capital equipment purchases they make."

The utilization rate assumption is a concept that in part helps determine payment rates for imaging services - the higher the rate, the lower the payment. With the passage of the health care law, the rate was increased.

"The utilization rate assumption has been changed from 50 to 75 percent," says Dr. Graham. "What that means is that in calculating the capital costs associated with the imaging apparatus, the cost per exam goes down and so the reimbursement per exam goes down. It's another mechanism that allows CMS and ultimately the other insurers to reimburse at a lower level," he says.

The new law also contains a disclosure provision, requiring self-referring physicians to reveal ownership and other facility locations to patients who need imaging services.

Although there is a lot of ambiguity around the health care law, not all of it is negative. It will potentially enable more people to access PET services. Dr. Graham expects more details to become apparent with time, awaiting more information from experts who can decipher the law.

"I don't know anybody who's read the whole thing," he says.

Cyclotron or accelerator?

In PET/CT, the system used to carry out the studies is only a part of the imaging equation. Providers also need to have access to the radiopharmaceutical doses necessary for the tests. Although some major research and educational facilities have their own cyclotron systems, the bulk of imaging facilities order their doses from a commercial distributor.

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