Money Is Not the Key to Modernizing Your Nuclear Cardiology Lab

Over the past 10 months, during the lead up to and since becoming ASNC president, Dennis A. Calnon, MD, MASNC, has talked with cardiovascular imaging professionals around the world about why nuclear cardiology lab modernization is crucial now. Most of Dr. Calnon’s audiences have quickly grasped the why behind his modernization message. Nuclear cardiology is facing challenges stemming from misperceptions about the value of myocardial perfusion imaging compared with so-called “competing” modalities, industry hype, and increasing insurer interference in test selection. What is keeping some nuclear cardiology labs from embracing modernization is the how. In many cases, it comes down to sticker shock, or the fear of how hefty the price tag could be.

“Many nuclear cardiology labs equate ‘modernization’ with buying a new camera, which no lab can just run out and do,” says Dr. Calnon. “There are, however, many other ways to approach lab modernization. Some won’t cost a penny and could even have an immediate positive effect on the service line’s revenue.”

ASNC asked stakeholders across nuclear cardiology for their thoughts on tackling lab modernization. Physicians, technologists, administrators … almost everyone told us some version of “Upgrade your camera if you can but, if that’s not feasible now, you have other options.”

Here we’ll take a look at some of those options you have for lab improvement and how many of them could pay big dividends for your patients, your practice and your field.

First, the Camera Question
No doubt, upgrading from a gamma camera to solid-state or PET technology would be a game-changer for most labs. “This equipment upgrade provides the greatest benefit for all three stakeholders,” says Denise Brown, principal at Reset Healthcare Consulting and a speaker at Nuclear Cardiology NOW: Strategies for Optimization, Efficiency and Productivity. “It delivers higher quality imaging for the physician interpreter, improved finances for the administrator or CFO due to faster testing times and throughput and, finally and most importantly, greater safety for our patients from reduced exposure times.”

A high-efficiency CZT camera or cardiac PET program could open new doors for your practice. For many labs, a new camera is a first step on a journey into offering new imaging services like measuring myocardial blood flow, assessing myocardial viability, and imaging for inflammation and infection.

Even if a new camera seems out of the question, don’t just take it off the table, Dr. Calnon advises. “Start thinking about how a camera could make your lab more competitive in your area, and begin talking to your team. Find an administrator who will partner with you on the research and financial analysis.”

Opportunities Available with Your Current Camera
Protocols: Your No-cost Ticket to Quality Improvement

“Even if you have no ability to upgrade and modernize your camera, you can work to optimize it,” says Ms. Brown. Our other sources echoed that sentiment. Most said protocols are the place to start.

“Do you have a protocol and process for every type of study you provide, and are your protocols current?” asks Carlos Ochoa III, division vice president of cardiovascular services at HCA’s Methodist Healthcare.

Answer these questions, and get your protocols up-to-date, says Mr. Ochoa, but then go a step further by assessing whether protocol changes are being clearly communicated to every single person involved in imaging your patients. In addition to being good for your patients, relentless adherence to the latest imaging protocols can spare you the challenge of backtracking to get prior authorization from a payer, he adds.

When Nuclear Medicine Director Erin Stevens, CNMT, NCT, came on board at Oregon Heart Center (OHC) nearly a decade ago, she zeroed in on the protocols the lab was using at the time. She did research and then talked to the clinic’s physicians about how they could produce better studies without adding cost while still imaging the same number of patients.

Success with protocol updates and other “smaller” issues helped Ms. Stevens grow into a leadership role at OHC and gave her the confidence to take a key part when the team began considering a PET camera acquisition. In 2019, OHC became the first center in Oregon to launch a cardiac PET program.

Scheduling: Where Efficiency Starts

If protocols are the #1 quality improvement change labs can make without investing dollars, scheduling is the least expensive operational tactic most labs can undertake “for the greatest yield,” says Ms. Brown. “If you have been operating under virtually the same schedule or nearly the same nuclear SPECT schedule for the past five years or more, then you have room for improvement.”

When it comes to efficiency dynamics, you have to look at the entire operation, says James M. Palazzo, division vice president of HCA Physician Services Group. “Understand what is limiting your efficiency and develop solutions around those issues. If it’s your camera, consider expanding your hours.”

Ms. Brown also recommends examining all of your scheduling options, such as extending the day in the morning and/or the afternoon or offering weekend hours. Don’t lose sight of your team’s well-being, she adds, but ask your team questions such as, “Could we stagger staffing to allow for mid-afternoon testing? Or could we dedicate a medical assistant to the team to solely focus on preparing the patient to allow the technical and nursing staff to focus on injecting, imaging, and stressing?”
 

Talk to Your People: Team, Referrers, Patients, and Beyond
Need help figuring out which modernization tactics are right for your lab now?

Your team has a wealth of information and insight you might not be tapping into, suggests Mr. Palazzo. “For example, ask your operators, “If we had another technologist, could you double your throughput?”

Mr. Sobal’s team also urged outreach to key audiences, including referring clinicians and patients. You could get valuable intelligence from these groups, he says. The clinicians “might ask you to alter the structured report to be clearer or more concise,” or the patients might say your pre-testing instructions and reminders aren’t as clear as you think they are. He suggests asking patients, “What would be a Wow experience?” You might be surprised at the small, inexpensive changes that could make a big difference to a patient.

Adopt a Future-focused Mindset

You must monitor what’s happening with – and projected for – your patient population. Worldwide, there’s a paradigm shift underway, with heart patients presenting with symptom and disease patterns different from even just a couple of decades ago, says ASNC President-elect Mouaz H. Al-Mallah, MD, MSc, FASNC. “We are seeing older, sicker patients who have more obesity, diabetes and atypical disease presentations. We are going to need to use different tools to care for these patients.”

Many geographic areas are also poised for population shifts, says Mr. Palazzo. Is your area set for a population explosion, or is it expected to remain stable? How fast is your community’s population aging? You need to understand these variables to forecast the demand for your services, he emphasizes. Understanding your demand forecasts will help you make informed decisions about equipment, space, technology, staffing and more.

It is crucial you know about the innovations in nuclear cardiology’s pipeline. It takes more than instinct to predict which advances will take off vs. fade away. You will need sound intel as you decide which modernization tactics to prioritize for your lab and how to make the case to your colleagues, administrators and even regulators, says Friederike Keating, MD, director of nuclear cardiology and the stress laboratory at the University of Vermont Medical Center and ASNC’s advisor to the CPT Editorial Panel.

“You need to connect with others nationally, or even globally, to get the right information to present and to justify why it’s important,” she explains. For that, there’s no substitute for the ASNC Annual Scientific Session and Exhibition.

“You go to the ASNC annual meeting and start picking up a vibe,” she says. “You see that 20 percent of talks are about this new subject. It’s the hum of the meeting. Then, the next year, it's 30 percent. You see there’s research, knowledge and usage, and that the community is using it in a way that makes clinical sense and answers a clinical question. Then, you can say, ‘We should have this,’ and you can justify it.”

Plus, the ASNC community is “very approachable,” Dr. Keating adds. “It’s easier than you think. You can ask anyone, “How did you do this? How did you get it established? Did you have trouble getting the regulators to approve it?”

‘The Time Is Now’
To meet the challenges ahead and transform care for patients, “We all need to be offering the highest quality testing,” says Dr. Calnon, “and that requires having modernized labs.”

What it does not require is doing everything at once, he adds. He is asking every nuclear cardiology team to take a single step forward. “Come to ASNC2022. Attend the sessions, visit the Exhibition, talk to people,” he invites. “Then take what you learn back to your lab, decide which aspect of modernization fits where you are, identify the people who will help you champion it, and get started. The time is now.”