Demand numbers for nuclear medicine show drop in 2006

As sure as the sun fades in the west, reimbursements for medical imaging set over time, a natural consequence of familiarity and increased demand, followed inevitably by increased productivity. But in 2006, the expected increase in demand did not happen in nuclear medicine.

In 2006, two million fewer nuclear medicine procedures were carried out in the U.S. than during the year before-17.7 million versus 19.7 million-according to a survey of more than 7000 nuclear medicine sites conducted by IMV Medical Information Division.

Demand rebounded in the first half of 2007, putting the imaging community on track for a year that looks better than 2006 but still not as good as 2005. By the end of 2007, U.S. providers will have performed 19.2 million nuclear medicine procedures, according to IMV senior analyst Lorna Young.

Nuclear medicine took more than a 10% hit in 2006 and remains under par a year later at least partly due to precertification requirements being imposed by insurance companies. Typically, these companies require that less expensive tests such as stress echo be done before SPECT. But these requirements have an uneven and unpredictable effect, according to Young. Different insurance companies develop similar but still different policies and apply them over various regions and localities of the U.S.

Precertifications could spell problems for other modalities, she said. Though these problems have not yet shown up, they loom on the horizon.

"Precerts are being set for other imaging modalities, including CT angiography, MRA, and PET," Young said.

The good news is that the problems are not intractable. Nuclear medicine may have bounced back because administrators have recognized the problems and done something about them.

"Radiology administrators may be making sure precerts are done early enough, or they may be taking the initiative to better manage patients," she said.

Another factor contributing to the lower volume in nuclear medicine may be reason for optimism to providers of other modalities. The increasing use of PET/CT for oncology may be cutting into nuclear medicine demand, just as CT angiography and MRA may be taking cardiac cases.

The widening diffusion of 64-slice CT and the largely unrealized potential of cardiac PET could have further impact on nuclear medicine. On the backside of this equation, however, is the possibility that SPECT/CT could lure some nuclear medicine cases back to the fold. This hybrid made up more than 10% of the gamma cameras installed in the U.S. in the first half of 2007, according to IMV.