State OK's medical scanners, renews cost debate
Caritas slams insurer for limiting coverage of the new technology
The state Public Health Council approved three new medical PET/CT scanning machines yesterday, bringing the total of approved units in the state to 22 and raising anew the debates about medical technology and costs.
The use of PET/CT scanners, which combine two types of radiological scans in one to create a highly accurate diagnostic tool, is growing fast in medicine.
Doctors can track the spread of malignant cancer cells in the body and the extent of damaged heart tissue in cardiac patients. It also is used to monitor epilepsy and Alzheimer's patients.
But like most new medical technology, the costs are high. The machines cost $2 million to $4 million to install, including structural renovations. The estimated costs of scans differs. The state estimates each scan costs $1,500 to $1,700, while hospitals said the range is $530 to $1,400, depending on the type.
Blue Cross Blue Shield of Massachusetts, the state's largest health insurer, covers the scans for many types of cancer, but not for breast cancer patients, which drew a public objection at yesterday's Public Health Council meeting from Caritas Christi Health Care.
''In this state, the only payer that will not pay is Blue Cross Blue Shield," said Dr. Kevin V. Loughlin, chief of radiology at Caritas Norwood Hospital. A PET/CT scan can quickly determine whether a chemotherapy regimen is working, giving doctors better information that could be used to change the chemo if it is not working, he said.
''It's something that we feel women need. We feel they are entitled to it. It's a quality of care that we feel they should have," he said. Caritas Christi has spent large sums providing the scans without reimbursement for Blue Cross patients, he said.
Medicare, the government-funded health plan for the elderly, does cover PET/CT for breast cancer. Medicare's decisions often guide coverage decisions by private insurance companies.
But the medical director in Blue Cross Blue Shield's division of medical innovation and leadership, Peter Goldbach, said the insurance company does not always follow Medicare's lead. Blue Cross reviews medical literature and looks to evidence-based studies to make coverage decisions, he said.
''When new technology comes along, its hard to know how to properly use it," he said. ''What we ask for is scientific studies that show its good for our members."
Blue Cross does cover the use of PET/CT for breast cancer in the Medicare managed-care option it offers, he added.
Questions of costs around PET/CT are similar to other debates about the rising costs of MRI. The questions are bound to continue as demand from doctors and patients grows.
A PET (positron emission tomography) machine shows the metabolic action of cells, by imaging how fast glucose linked to a radioactive tracer is absorbed by cells. Cancer cells metabolize the glucose faster.
The opposite holds true for diseased heart tissue -- the cells do not absorb the glucose or absorb it poorly. Combining the PET scan with a CT (computerized tomography) scan allows doctors to precisely pinpoint the location in the body.
In Massachusetts, which tightly controls the introduction of new imaging machines, the greatest concentration of PET and PET/CT scanners is in Boston teaching hospitals, but they are quickly spreading to community hospitals.
Last year, the state approved new PET and PET/CT units at Emerson Hospital in Concord, Lahey Clinic in Burlington, for the Southcoast Hospitals Group, and a jointly operated machine for Mount Auburn Hospital in Cambridge and Winchester Hospital.
Two of the three units approved yesterday will be operated by the physician groups for Massachusetts General Hospital and Brigham and Women's Hospital. The third will be a mobile unit operated by Caritas Christi, the chain of six hospitals owned by the Catholic Archdiocese of Boston. It will be the second mobile unit operated by Caritas Christi.
The state estimates demand to grow for another seven machines by 2010, bring the estimated total to 29.
In addition, there are three or four other machines that have been installed outside the state regulatory process, under so-called ''exemption letters" awarded to a handful of doctors in 1993 before the Legislature mandated regulations on the new technology.
The demand is rising even as insurance companies are looking for ways to check the spread of the expensive tests.
Insurance companies have established procedures where physicians ordering PET/CT scans must seek advanced permission or at least give the insurers a special notice.
''The medical community wants to afford its patients the best diagnostics medically available," said Paul Dreyer, director of the state Division of Health Care Quality. ''The payers lag a little bit behind the technology."
Christopher Rowland can be reached at firstname.lastname@example.org.