Nuclear Medicine Facility Survey: SNM 2003 Survey Reporting on 2002 Cost and Utilization

Hospitals Size and Operation Hours

Hospital data were sorted by bed size ranges as follows: 0–125, 126–300, 301–499 and 500+ beds. The number of licensed hospital beds in these facilities ranged from 15 to 1,100 with an average of around 212 beds. The majority of hospitals, 67%, reported they were community-based facilities, 23% were private, 8% were government, and 2% were university hospitals. In the range “0–125 beds”, 68% were community hospitals and none were university hospitals. In the range “500+ beds”, 47% were community hospitals and 12% were government hospitals.

Several survey items were designed to understand the operational aspects of facilities and to ensure we would be able to compare volume with like facilities for benchmarking. The respondents for each survey were asked to provide days and hours of operation as well as wait times. The majority of hospitals operated at least 5 days per week with 66% of the hospitals offering routine nuclear medicine procedures 5 days a week, whereas another 29% of the hospitals offered services 6–7 days per week. Of the smaller hospitals (0–125 beds), 74% of the hospitals offered nuclear medicine services 5 days a week. More than half of the hospitals with more than 300 beds offered nuclear medicine services 6–7 days a week. Of the hospitals surveyed, 45% were open 45 hours or less per week for routine nuclear medicine patient services. Smaller hospitals tended to be open for fewer hours than larger hospitals. Of the hospitals in the “0–125 beds” category, 65% were open 45 hours or less for routine nuclear medicine services, whereas 30% of the hospitals with 500+ beds were open 80 hours per week or more. These data suggest there are differences between large and small hospitals regarding volume; therefore, we are supplying detailed procedure volume data by hospital size. (See Table 2.)

When responders were asked about the average wait time for nonurgent nuclear medicine procedures, 58% of the hospital-based facilities reported an average of 2 days or less for nuclear cardiology procedures. A wait time of 3–4 days for these procedures was reported by 16%, whereas 12% reported wait times of 1 week or more. For PET procedures, 14% of the hospital-based respondents indicated wait times for PET procedures of 1 week. For all other nuclear medicine procedures, 64% reported an average wait time of 2 days or less. None of the hospital-based facilities had a wait time of more than 3 weeks.

Hospital Purchasing Practices

We next asked facilities to tell us if they planned to upgrade or purchase new equipment in the next year. Approximately 42% of the hospital-based facilities indicated that their facility was planning to upgrade or purchase nuclear medicine equipment in the next year. Interestingly, 80% of these upgrades or purchases were for SPECT equipment. We call your attention to the fact that this survey was performed in the fall of 2003 so this expected purchase of SPECT equipment should have taken place in 2004. It will be important to monitor this moving forward, especially in light of the new SPECT/CT and PET/CT equipment, to see if purchase practices are changing.

We understand facilities have options regarding the method of purchase of their radiopharmaceuticals so we asked the respondents to tell us, in general, how they purchase their radiopharmaceuticals. We did not ask for details or specifics on each radiopharmaceutical so the information presented is generalized. Of the hospital-based facilities, 76% said that they purchased their radiopharmaceuticals as commercially prepared single-unit doses. In-house preparation of radiopharmaceuticals was reported by 20%, and 4% reported purchasing commercially prepared multi-dose radiopharmaceuticals. While the majority of facilities did report that they purchase commercially prepared unit-dose radiopharmaceuticals, the breakdown by hospital size shows that very small and very large hospitals were more likely than moderately sized hospitals to prepare radiopharmaceuticals in house. (See Table 3.)

The survey also asked respondents to provide specific radiopharmaceutical frequency, cost, and administered dose data. Table 4 provides this detailed data. In an effort to present a simplified table, the data is not broken down by hospital size. As noted above, if less than 5 facilities reported on a radiopharmaceutical, we did not report the results. Because government agencies have put great emphasis on the cost of drugs and radiopharmaceuticals, we have decided to present both the mean and median costs.

Due to the large amount of data provided in Table 4, we will leave the detailed review and comparison to the reader. We caution readers who plan to use any of this data for benchmark purposes—carefully review the description of the radiopharmaceuticals and drugs because many of the HCPCS code descriptions changed since 2002.

We would like to make a few general observations as follows: There was little variation in the reported radiopharmaceutical doses between hospital-based and nonhospital-based facilities; we found no significant differences in the median costs for most of the radiopharmaceuticals; there were, however, differences between hospitals and nonhospitals regarding frequency. Note: Two radiopharmaceuticals were reported and analyzed in 2 sections of the survey tool. Information on both is provided.

Hospital Procedures Performed in Calendar Year 2002

The next series of data is provided for facility benchmark purposes. Among hospital nuclear medicine facilities that perform in-patient procedures, an average of 1,253 procedures were performed per facility in 2002. As noted earlier, not all facilities responded to our request for total procedure data. However, 418 respondents (83% of the hospital-based facilities) responded to the question on total number of inpatient nuclear medicine procedures performed in 2002. Hospital-based facilities averaged 2,318 outpatient nuclear medicine procedures in 2002 with a minimum of 5 and a maximum of 25,075. Of the hospital-based facilities, 96% reported performing cardiac nuclear medicine procedures. Of the cardiac nuclear medicine procedures performed in 2002, myocardial perfusion stress tests (code 78465, MPI multiple studies stress and rest) were performed most frequently which is consistent with other reported government hospital data. Of the hospital-based facilities, 64% performed therapeutic nuclear medicine procedures. Of the hospital-based facilities, 18% performed PET nuclear medicine procedures while 93% performed other procedures. Bone scan was the most commonly performed procedure in 2002 with an average of 567, and the least common procedure was 78760–78761, Testicular Imaging. In general, for each code, the number of procedures performed increased with the hospital size. (See Table 2.)

Nonhospital Size and Operation Hours

The nonhospital data were sorted into the following categories for analysis; general nuclear medicine only, cardiac only, general nuclear medicine and cardiology, and other. The responses showed that 42% of the facilities surveyed were nonhospitals. Of these, 36% offered cardiac only, 13% offered general nuclear medicine only, 25% offered both, while 26% offered all other specialties. Additionally, nonhospitals responded that 23% were multi-specialty physician offices, and 45%, single specialty offices.

We asked the same or similar questions to the nonhospital facilities as we did to the hospitals. Regarding operational days and hours, 86% of nonhospital facilities offered routine nuclear medicine procedures 5 days a week; another 10% offered services 3–4 days per week. Of those specializing in cardiac only, 90% offered nuclear medicine services 5 days a week and 8%, 3–4 days per week.

Of nonhospital facilities, 64% were open 45 hours or less per week for routine nuclear medicine patient services. This was comparable to smaller hospitals, 65% of which reported offering nuclear medicine services 45 hours or less per week. These results suggest that for benchmark procedure volume and other cost purposes, a comparison of small hospital (0–125 beds) data would be appropriate with total nonhospital data, as the hours of operations are similar. Facilities specializing in general nuclear medicine only had the highest percentage reporting 45 hours or less (80%). Of the nonhospital facilities, 24% were open 46–55 hours per week. When asked about the average wait time for nonurgent nuclear medicine procedures in nuclear cardiology procedures, 44% of the nonhospital facilities reported an average wait time of 2 days or less. For all other nuclear medicine procedures, 23% reported a wait time of 2 days or less.

Nonhospital Purchasing Practices

Regarding purchasing practices, 27% of the nonhospital nuclear medicine facilities planned on upgrading or purchasing nuclear medicine equipment next year, and 31% of the cardiac-only facilities planned on upgrading. Both of these percentages were lower than reported by hospitals. However, similar to hospitals, for those who were planning an upgrade, a very high percentage (91%) were upgrading to SPECT equipment, and, interestingly, 4% of nonhospitals reported plans to upgrade to PET/CT, higher than reported by hospitals.

Another interesting significant difference was identified by the survey regarding radiopharmaceutical purchase method. In contrast to hospitals, on average, 98% of nonhospital facilities said that their radiopharmaceuticals were commercially prepared unit dose, much higher than the hospital average of 76%, reported earlier. The remaining nonhospitals were equally split between commercially prepared multi-dose and in-house preparation. (See Table 3.)

Nonhospital Procedures Performed in Calendar Year 2002

The average number of outpatient nuclear medicine procedures performed in nonhospital facilities was 2,093. The percentage of respondents to this question was 84%. Facilities that performed cardiac nuclear medicine averaged 1,279 SPECT myocardial perfusion imaging multiple procedures annually. Only 12% of nonhospital facilities performed therapeutic nuclear medicine procedures in 2002, significantly lower than hospitals at 64%. PET procedures were performed in 7% of nonhospital facilities compared to 18% of hospitals. Of the nonhospital facilities, 90% performed cardiac nuclear medicine procedures in 2002, compared with 96% of hospitals. In general, the most frequently performed procedures were cardiac and musculoskeletal.

This survey was quite comprehensive, and we were pleased that so many technologists were willing to expend the considerable time that it took to complete it. It is clear there are both similarities and differences between nuclear medicine as practiced in hospital-based and nonhospital-based facilities; therefore, measurements at this level of detail are recommended for future surveys. We plan to repeat many aspects of this survey in the future. This survey will provide a basis for future comparisons, will help us understand trends, and will assist us in planning for the future of nuclear medicine.