Ideas for Hospitals, Centers and Practices

Manufacturer Offers Solution to Isotope Shortage
OrthoCarolina Inks PACS Agreement with Philips
One Reason for One Call: Build Volume!

Manufacturer Offers Solution to Isotope Shortage

While the worldwide shortage of technetium-99m (Tc-99) is causing concerns in nuclear radiology departments across the United States, Bracco Diagnostics Inc’s Princeton, NJ-based division is offering an alternative to this key radioisotope for PET scans.

Bracco’s CardioGen-82 is being used in many major hospitals for myocardial imaging. The device uses strontium-82 (Sr-82) to generate a rubidium-82 (Rb-82) isotope for perfusion during imaging. There are several advantages to using the Food and Drug Administration-approved CardioGen device. The isotope?which has a half-life of 75 seconds?can be generated on site and is perfused directly from the generator, meaning that there is no need for a physicist and it limits patient and technologist exposure. Scans using the CardioGen device tend to be faster, about 30 to 40 minutes as opposed to several hours. For certain patients?such as large-breasted women and large men?Rb-82-based imaging seems to have less attenuation, giving radiologists a higher level of diagnostic certainty.

Bracco’s CardioGen-82 is being used by many major hospitals for myocardial imaging.

Not only having an alternative, but one that is reliable is crucial. According to Bracco, its CardioGen PET images have a 96% diagnostic certainty compared to SPECT (at 82%). “It’s easier to interpret the images, so you can send the patient home or on to the cath lab [right away],” said Jim Waples, associate director of nuclear medicine marketing for Bracco.

But, most important, until a reliable source of Tc-99 can be secured, is that Sr-82 is readily available and can be on site 24 hours a day, 7 days a week, making departments more efficient and less prone?at least with myocardial imaging?to having long delays or resorting to rationing care. The Sr-82 fuel has a 28-day half-life.

About 50% of the United States’ supply of Tc-99 comes from the Chalk River generator in Ontario. Unfortunately, because of technical and maintenance issues, the generator has been unable to remain operational for more than short periods of time over the last year, which has resulted in the shortage in the United States. Waples said that it’s probable that the generator will not be back to full operational capacity until the first quarter of 2010.

About 80% of all nuclear imaging tests use Tc-99, according to the US Food and Drug Administration.

For its part, the FDA is working with manufacturers to increase the production of Tc-99, is keeping in contact with health care providers to inform them about the shortage and how it’s being resolved, and is maintaining a Web site devoted to the Tc-99 shortage.

During the crisis, radiology departments have two options. The first is to ration their available Tc-99 for tests involving their most critical patients or to schedule tests in such a way that it will optimize the isotope’s yield. The second is to use alternative isotopes. Rb-82 is only one of these on the FDA’s list. For coronary artery disease, clinicians can also use thallium-201 for gamma scintigraphy, and ammonia N-13 for PET/CT, echocardiographic stress, or electrocardiographic stress tests. For suspected bone lesions, the FDA recommends 18F-Fluorodeoxyglucose PET/CT, or sodium fluoride-18 PET/CT as alternatives. It also recommends the use of non-nuclear modalities such as CT and MRI.

Waples notes that the Rb-82 isotope is nothing new. In fact, according to Bob Kovac, the CardioGen product manager, the company has seen a double-digit growth in the use of the device over the last 5 years. “For those that have PET scanners, it gives them an option when there’s a shortage,” he said.

?C.A. Wolski

OrthoCarolina Inks PACS Agreement with Philips

OrthoCarolina, one of the largest orthopedic practices in the nation, has signed an 8-year iSite PACS expansion deal with Philips. Formed by the merger of Charlotte Orthopedic Specialists and Miller Orthopedic Clinic in 2005, OrthoCarolina boasts 76 physicians, 39 PAs, 68 physical therapists, and 800 employees. They had 520,000 patient encounters, conducted 17,000 MRIs, and performed 38,000 surgeries in 2008.

In 2004, Philips iSite PACS won the “Best in KLAS”s award for PACS for the second consecutive year. As of March 31, 2005, more than 131 customers representing more than 239 of North America’s leading hospitals and medical facilities have adopted the Philips approach to image and information management, according to Philips.

Many hospitals looking for a PACS already have a RIS/HIS in place and may not wish to spend millions on a new RIS and endure the lengthy RIS installation process. While the value of integration is high, the acquisition costs and potentially disruptive organizational impact of a complex and lengthy implementation must be evaluated. Integration is crucial, but choosing the best PACS and RIS system is essential. Integrating Philips iSite PACS with a best-of-breed RIS solution ensures flexibility, freedom of choice, and enhanced workflow, while exploiting the power of both applications in an integrated best-of-breed environment.

OrthoCarolina first chose the scalable Philips iSite PACS system in 2006 as the practice looked for a better way to manage its complex system of locations. iSite PACS’s fee-per-study model allowed OrthoCarolina the flexibility to grow its PACS system as it began to convert each location from analog to digital radiography (DR). After reporting a positive initial experience with iSite PACS, OrthoCarolina continues to see Philips as its vendor of choice while entering the final phase of its conversion to DR.

“Our physicians travel regularly among our 16 offices and need access to images taken at any of our locations,” said Steve Hendrick, chief information officer of OrthoCarolina in a press statement. “With iSite PACS’ ability to distribute across the enterprise, our physicians are able to pull up images at our satellite offices from our server downtown in seconds and better serve our patients. Renewing our partnership with Philips was a logical extension of our relationship, and iSite PACS continues to meet the growing needs of OrthoCarolina’s more than 70 physicians.

“Philips is partner minded, they don’t bear hug clients,” said Hendrick. “They provide an open API (Application Programming Interface) tool kit that greatly enhances workflow.” Although he says their system is more rigid than others?”They only have one flavor of configuration”?he maintains this rigidity has benefits for OrthoCarolina. “Performance is predictable so we don’t have to deal with variations one gets with hosted outsourced vendors. We’re able to budget more effectively and forecast expenses.

“iSite is a more stable product,” Hendrick added. “And with our high volume and fee-per-study price structure, it’s ultimately cheaper.

“Philips provides a turnkey system with better support and a performance guarantee,” Hendrick said. “We get the best of both worlds, pricing flexibility, and high-end PACS performance. Doctors don’t have to search and scroll for images or toggle back and forth to find what they’re looking for. Response time is the quickest in the industry. “

Once the conversion to DR has been completed by early 2010, OrthoCarolina expects to store about 290,000 new images per year on its iSite PACS system. Images will come from a variety of modalities, extending beyond radiography to include MR and ultrasound.

?James Markland

One Reason for One Call: Build Volume!

One Call Medical Inc (OCM), a specialized preferred provider organization (PPO) headquartered in Parsippany, NJ, commissioned a survey that found radiology specialty networks play a critical role in channeling patients to imaging centers for both workers’ compensation and health insurance patients. To meet this growing demand, the company has moved and expanded its West Coast Call Center, relocating it to West Hills, Calif. OCM’s network provides coverage in major metropolitan areas of the United States.

Tracee Melby-Thompson

“By expanding West Coast operations, we’ll be better able to meet the growing needs in workers’ compensation and health care to promptly schedule patients for diagnostic testing within our network of quality providers,” said Kent Spafford, OCM CEO, in a release. “We currently schedule most tests within 24 hours of receiving a referral and promptly deliver accurate test results, so patients can go on to receive the treatment they need.”

Tracee Melby-Thompson, senior vice president of marketing and sales for PresGar Companies in Tampa, Fla, can attest to the fast service delivery. “People come in from One Call, and they can’t believe someone reached out to them already,” said Melby-Thompson.

OCM patients seen in PresGar facilities have typically been contacted by the OCM nurse case manager within 24 hours of their injury and sometimes as rapidly as within 6 hours. “I don’t know that we would be able to do as good of a job because it is not our sole dedication. It’s one component of what we try to do every single day,” said Melby-Thompson.

PresGar owns and operates diagnostic imaging facilities throughout the United States. Services include MRI, CT, PET, bone densitometry, ultrasound, mammography, fluoroscopy, and radiography. PresGar has contracted with OCM for group health and workers’ compensation services.

Why Call

Melby-Thompson notes this relationship brings a lot of efficiencies to the practice. OCM handles the scheduling, authorization, and follow-up of the patients it refers to PresGar. “They are able to absorb some of the functions that normally we would pay somebody to do at the front desk,” said Melby-Thompson. Gathering workers’ compensation information or having to track patients down for follow-up visits can be time-consuming tasks.

The savings in time and labor balance the cost of the service. “There is a little bit of grumbling in radiology across the board right now in terms of reimbursement,” said Melby-Thompson, noting that OCM does not pay top dollar. But, she adds, the PPO delivers the volume, efficiency, and service to make the arrangement reasonable.

OCM’s survey, conducted by Lead Generation Solutions, found that specialty networks are responsible for directing 44% of workers’ compensation patients seen by imaging centers and 18% of patients with health insurance. Other valued services cited by the 140 centers surveyed include clear contract and service requirements, good provider service, and timely and accurate payments.

“One Call has been true to their word on delivery of service,” said Melby-Thompson, referring to the PPO as a partner. PresGar and OCM have worked together on marketing activities, industry research, electronic delivery format, and education in the form of CEU credits and physician presentations.

The collaboration is not indicative of typical industry patterns. “You can spend 4 hours on the phone just trying to find the right person to speak to in some insurance companies, so you appreciate the ability to call somebody and get something accomplished,” said Melby-Thompson. With the larger call center, OCM expects to increase staff and upgrade technology to further improve its ability to respond in one call.

?Renee Diiulio