Purchasing top-of-the-line imaging equipment may seem to be a good idea for outpatient centers that want to distinguish themselves in often crowded markets. But today's economics are making it harder and harder for outpatient imaging centers to justify the cost of a 64-slice CT or 3T magnet.

The Deficit Reduction Act of 2005 (DRA) has slashed Medicare reimbursement for some imaging centers by 25%. Other payers have followed suit and reduced payments equivalently.

"When Medicare and the insurers pulled the rug out from everybody, a lot of imaging centers with capital at risk had no place to go. Many of the centers that had invested in the highest end technology are out of business, and the people who gave them the money are taking the equipment back," said Dr. Peter Mezzacappa, director of Freehold Radiology Group in Freehold, NJ.

Freehold's three imaging sites are providing high-quality imaging without the bells and whistles. The two 1.5T scanners at its flagship site are running scans every half hour. A 1.5T unit in nearby Toms River is holding its own in an area that is packed with MRIs.

"There are 14 magnets within the surrounding three miles, but we are able to compete effectively with our 1.5T scanner against high-field and open magnets of every variety and flavor because of our excellent image quality, attention to detail, turnaround times measured in hours, and convenient appointment times," Mezzacappa said.

Hartsdale Imaging in Westchester, NY, is doing the lion's share of its CT imaging on a 16-slice scanner.

"Ninety percent of the clinical work you do on a CT scanner involves imaging the brain, sinuses, orbits, head and neck, chest, abdomen, pelvis, or musculoskeletal system, which does not require a 64-slice or 128-slice machine or a dual-source scanner. A 16-slice scanner also may be used for CT angiography in straightforward, uncomplicated cases as long as a discrete, limited volume of anatomy is selected to ensure good image quality," said neuroradiologist Dr. Adam Davis.

In these tenuous economic times, outpatient imaging centers are finding that they don't have to assume the extra cost of topof- the-line equipment to offer top-notch imaging services.

"We've had the opportunity to look at purchasing a high-end scanner, but the economic climate is not favorable right now.

The three sites that I run are very pragmatic. We don't invest in technology that is not going to give us better throughput or provide us with a significant benefit. I'm not convinced the cost/benefit ratio for the highest end technology makes sense for outpatient imaging," Mezzacappa said.

THE ECONOMIC SCENE

Healthcare has been considered one of the industries that are recessionproof.