"Our focus is on selling those kinds of products that match the budget of someone who doesn't want to spend $15,000 to $20,000 on a premium-branded product," Huckestein says.

Currently, cardiologists use machines in their private practices, but Huckestein speculates that practices might revert back to the old trend: directing patients to a hospital for stress testing.


"Reimbursement is now less than $100 - the national average," he says. "We are seeing a new trend now where the primary care market is referring stress text exams to their local hospitals or cardiology groups. When the market was favorable, we saw the opposite. Outsourcing is now the trend versus performing these exams in-house. The costs just don't justify the means."

"Our response to that is, 'Hey, let's give doctors what they want, and that's something less expensive,'" says Huckestein.

But Joe Avina of American International Medical, a refurbishing company, says the trend toward mostly foreign secondary companies will be short-lived.

"We're already getting people on the rebound," he says. "They tried it and want American."

Avina says the refurbishing market is booming right now, as more and more providers turn to less expensive equipment; he says the average price for a refurbished PC-based system is $12,000 to $15,000, and $5,000 to $9,000 for a traditional test.

American International Medical boasts a 40 percent increase in sales from last year, and it's expected that number will grow.

"A major trend is huge growth in requests for refurbished systems," he says. "I think it's the economy."

But the passage of health care reform is also expected to drive sales in the refurbished market, he explains. This could be attributed to the millions of Americans who will receive health coverage under the new law.

"[The health care law] seems to be increasing activity tremendously," he says. "I see it because we're in this market. We're going to benefit from the health care reform."

Correction boosts reimbursement

The Centers for Medicare and Medicaid (CMS) announced last month it would boost reimbursement for SPECT nuclear imaging by 16 percent. The increase is a correction to the 2010 reimbursement, which cut nuclear stress testing to 36 percent, according to a CMS report.

"This is a very significant occurrence, perhaps among the most important, especially since Obama has become president, as far as cardiologists are concerned," says Avi Soffer, CEO and vice president of University Nuclear & Diagnostics.

The cut decreased from 36 percent to 20 percent, which will allow cardiologists some breathing room, Soffer says.

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