There are dozens upon dozens of services that a cardiology office may offer. It can be overwhelming for a newly independent cardiologist to decide what technology and services to invest in first. Digirad works with thousands of cardiologists and we’ve compiled the five most essential services for any cardiologist thinking of opening his or her own office.
Perhaps most essential for any cardiology office is an electrocardiogram (EKG) machine in order to test for problems with the electrical activity of a patient’s heart. EKGs are useful for evaluating the possible causes behind unexplained chest pains as well as the efficacy of medicines and medical devices, such as a pacemaker.
Stress tests are essential for determining the amount of stress that a patient’s heart can manage before developing either an abnormal rhythm or evidence of ischemia.
Echocardiography is routinely used in the diagnosis, management, and follow-up of patients with any known or suspected heart diseases. Echocardiography can help detect cardiomyopathies, such as hypertrophic cardiomyopathy, dilated cardiomyopathy, and many others. Currently, it is one of the most widely used diagnostic tests in cardiology. Stress echocardiography is a subset of echocardiography. By utilizing stress tests during patient evaluation, stress echocardiography may help determine whether any chest pain or associated symptoms are related to heart disease by visualizing wall motion differences between stress and rest.
SPECT Myocardial Perfusion Imaging
SPECT myocardial perfusion scan (MPI) is a nuclear cardiology procedure that highlights the function of a patient’s heart muscle. MPI is useful for diagnosing a variety of heart conditions such as coronary artery disease, hypertrophic cardiomyopathy, and heart wall motion abnormalities. Images are usually acquired at both Stress and Rest allowing physicians to evaluate heart muscle perfusion to determine normalcy, ischemic, or infarcted areas.
Full Spectrum Cardiac Rhythm Event Monitoring
Cardiac rhythm event monitoring includes a variety of noninvasive tests necessary for all cardiology offices. Among the types of monitoring tests are Holter monitoring, event monitoring, and mobile telemetry, all of which involve collecting data from the patient over a period of time for suspected cardiac arrhythmias or to measure the efficacy of treatment.
Opening your own Nuclear Cardiology lab provides you with dedicated access to SPECT Myocardial Perfusion and function studies. However, the cost to set up and maintain a Nuclear Cardiology lab can be overwhelming. Before deciding if a nuclear cardiology lab is right for your practice, it’s important to be aware of the all the associated cost factors.
You will need to purchase a SPECT myocardial perfusion imaging system. This is typically a dual-head or triple-head nuclear gamma camera. Also, if you don’t already have one, you will need a treadmill system. Additionally, there is the cost associated with equipment repair and maintenance. This typically involves a service agreement with the manufacturer.
Installing and operating a hotlab requires specific equipment and supplies. At a minimum, you will need to purchase the following for your hotlab:
- Dose calibrator
- Geiger-Müller (GM) counter
- L shield
- Lead bricks
- Syringe shields
- Lead-lined decay bins
In addition, a Quality Control Cobalt-57 flood sheet source must be purchased annually, and a Quality Control Phantom is required for ACR accreditation.
You must ensure that you have adequate space for testing and the lab. This may require the purchase or lease of additional office space, or it may be an opportunity cost associated with allocating dedicated space for the camera or lab that could be used for other patient or revenue-centered use.
Accreditation and License
There are a number of costs associated with your accreditation and license, which are required for reimbursement including:
- Cost of time and resources preparing for initial Accreditation
- Accreditation Application fee to IAC or ACR
- Renewal Accreditation fees every three years
- Radioactive Materials License (RML) initial application fee
- Annual RML maintenance fee
- Cost of maintaining a Radiation Safety Program, which includes ongoing quarterly meetings and documentation.
To learn more about the IAC Accreditation process, take a look at an earlier article from the Digirad blog…
Although it is easily overlooked, don’t forget the recurring cost of supplies for your lab. This includes:
- General medical supplies (IVs, syringes, leads, tubing, saline)
- Pharmacological stress agents
Labor and Consultation Fees
Once you have set up your lab, you must pay for the labor to help support that lab. Labor may include:
- Nuclear medicine technologist
- Cardiac stress technician
- Billing and reimbursement support
You may also have to compensate a nuclear cardiologist for interpretations or a radiation safety officer if you don’t already have one in house that can meet the Authorized User requirements on your radioactive materials license.
In addition to office labor, you will also need to pay for physicist consultation fees for the radioactive materials license application and the ongoing maintenance and record review for license compliance.
Finally, it’s important to remember that you will need IT and infrastructure support to manage data storage and image archives. The support must also cover anything associated with HIPAA Omnibus compliance, which covers the security and privacy of protected health information.
After completing a cost-benefit analysis, you can determine if opening your own nuclear cardiology lab is the right choice for your practice, or if it would be more cost-efficient to use a third party mobile nuclear imaging lab.