Hospitals seek more body scanners

Massachusetts hospitals are seeking to nearly double the number of advanced diagnostic body-scanning machines in the state, expanding a technology race throughout Boston and pushing it deeper into the suburbs.

The rush to add 10 positron emission tomography, or PET, scanners would bring the total to 22 and make the latest diagnostic technology for cancer and heart disease more widely available to doctors and patients.

But health insurance companies -- already struggling to curb use of the more common magnetic resonance imaging, or MRI, and computed tomography scans, or CT -- warn that additional PET scanners will burden the healthcare system with unwarranted costs.

They predict hospitals, especially community facilities, will be pressured to recover their investments in PET scanners, which can cost up to $3 million each to install.

''Our concern is that once a facility buys a very expensive piece of equipment, they are going to be pushing doctors to refer patients in order to pay for it," said Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans.

The push for more PET scanners follows delays imposed by the state Department of Public Health, which regulates hospitals' investment in advanced and expensive technologies. After approving eight machines in 2002, the state did not approve new PET scanners for three years while it developed a new method to measure demand.

Now, state approvals are flowing again. The Department of Public Health on Tuesday approved four scanners. Three applications could be approved next month, and hospitals recently filed applications for three more scanners.

''There is pent-up demand," said Ellen Zane, chief executive of Tufts-New England Medical Center, one of the four hospitals that received the go-ahead Tuesday, more than two years after it applied.

''When it becomes the standard of care, it becomes harder to hold back the technology," Zane said.

PET scanners allow doctors to estimate the spread of cancer or the extent of cardiac disease without surgery or invasive procedures and the technology is rapidly advancing. The newest machines sought by hospitals combine PET and CT scans to make even more accurate, three-dimensional images of body functions.

The federal Medicare program, which sets benchmarks used to guide insurance coverage throughout the country, has helped fuel demand for PET scanners by increasing the number of approved uses for the machines. It has boosted the number of diagnostic tests for cancer that require PET scanners to 23 this year from three in 2000.

''It's a rapidly emerging technology, particularly as the reimbursement climate has changed with Medicare," said Joan Gorga, director of the state Determination of Need program, which oversees new infrastructure improvements in healthcare.

As a result, costs are increasing quickly. A single scan can cost $3,000. Medicare spending on all advanced imaging tests, including PET, CT, and MRI, grew 22 percent from 1999 to 2003, to $9.3 billion, faster than any other physician service, according to federal data.

Hospitals argue that better technology will over time help control costs.

''This high-tech diagnostic information ultimately saves money because it directs correct medical decisions," said Dr. Robert Licho, director of nuclear medicine at UMass Memorial Medical Center in Worcester, which also received state permission for a PET scanner this week. ''It helps you carefully target therapies and avoid unnecessary surgery."

In addition to Tufts-New England and UMass Memorial, Boston Medical Center and Emerson Hospital in Concord won approvals from the state Department of Public Health Tuesday. Emerson's approval was limited to the use of a mobile PET unit on its campus two days a week.

The state next month is expected to consider applications from Lahey Clinic, Southcoast Health System, and a joint application from Mount Auburn and Winchester hospitals. State officials said additional requests have been submitted by Massachusetts General Hospital's physicians' group, Brigham and Women's Hospital, and Caritas Christi Health Care, which has seven hospitals in its network.

Emerson Hospital's vice president of strategic planning and market development, Christine Gallery, said there is demand among community physicians to bring high-tech diagnostics into the suburbs.

''There's no reason patients should have to go downtown," she said.

Christopher Rowland can be reached at crowland@globe.com.