Hospitals Make Push For PET Scanners Here

June 5, 2002
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GRAND RAPIDS — West Michigan health care providers, limited by a state rule that many say needs to change, are probably a year or two away from getting the latest high-tech diagnostic tool that gives doctors a better look inside the human body.

Present rules under the Michigan Department of Community Health’s Certificate of Need program limit to three the number of positron-emission topoghraphy (PET) scanners licensed in a state of nine million people. Detroit-area hospitals have all three licenses. That means physicians in West Michigan who want a PET scan done on a patient have to send them to the other side of the state.

“We just think that’s inappropriate and not acceptable for our patients,” said Bill Rietscha, vice president of operations for Spectrum Health.

While the state is willing to change the rules, it likely won’t do so anytime soon. The problem is that the Department of Community Health will only take on two certificate of need rule changes at a time, and other issues sit ahead of PET scanners on the agenda.

“The state is not going to change for some time now,” said Lody Zwarensteyn, president of the Alliance for Health.

The Grand Rapids-based regional health care planning agency this month urged the state to give higher priority to changing the rules governing the licensing of PET scanners so other areas of the state can access the technology.

Spectrum Health and Saint Mary’s have teamed up to bring a PET scanner to the Grand Rapids area, but it won’t happen until the Michigan Department of Public Health changes the standards to allow the licensing of additional scanners.

“There’s no reason for the slowdown other than the state’s willingness to put resources to policy-making,” Zwarensteyn said. “This isn’t a problem of the system not working. It’s a problem of people running the system who aren’t giving it the priority it needs to work.”

The state’s certificate of need commission agreed in March to form an ad-hoc committee to examine changes in PET scanner standards. The panel’s formation will occur in July with formal action by the commission, Department of Community Health spokeswoman Geralyn Lasher said.

The commission, however, hasn’t set a timeframe for having new standards in place. A wait of a year or two before additional licenses could be issued “would sound reasonable,” Lasher said.

PET scanners provide doctors with a computer-generated image of the biological activities within the human body. Physicians use PET as a diagnostic tool in planning treatments for cancer, cardiac and neurological patients. The device potentially can avoid the need for a patient to undergo an invasive procedure.

Health insurers only recently began reimbursing providers for PET scans.

The Health Care Finance Administration, the federal agency that administers Medicare, agreed in December to cover PET scans used in planning treatments for six different types of cancers — lung, colorectal, lymphoma, melanoma, esophageal, and head and neck. HCFA is reviewing the extension of coverage for several other cancers, as well as additional applications — breast cancer, dementia and myocardial viability. The agency has also received additional requests to cover PET procedures for many more cancers, and one cardiac and two neurological applications, according to HCFA.

“The value of PET is really being rapidly recognized,” said Debbie Stiemann, vice president for strategic advancement at Saint Mary’s Medical Center.

But the potential that PET scanners hold has also generated the classic cost-benefit ratio debate that arises whenever technological advancements are made in health care. The question is whether health care providers will start using costly PET scans as a routine part of a patient’s diagnosis when a less-costly procedure is sufficient.

“Is good care going to be defined as doing everything? The concern is that this is going to be additive,” Zwarensteyn said. “Nobody wants to be deprived of anything, but nobody wants runaway health care costs.”

PET scans can cost as much as $3,000 or more per procedure. But that price potentially could be offset in the long run if a procedure detects a disease in the early stages and enables the patient to undergo a non-invasive, less costly course of treatment.

“If you avoid surgery, as opposed to using drugs, you’ve saved a lot of money in the long run,” said Loren Rhoad, area sales manager for Alliance HNI, a Milan, Ohio firm that sells and leases medical imaging equipment.

While the Alliance wants the state to open the door for more PET scanners in Michigan, one member of the agency’s committee that reviews local applications doesn’t want it opened too far.

Michael McMillan worries that too many PET scanners will only drive up the cost of health care as providers make the costly investment for a device and then seek to recoup the expense through higher fees.

“Once the door gets opened, there’s a flock. We really need one of these in West Michigan, but we don’t need 25 all over the state,” said McMillan, recorder for the United Food Commercial Workers union Local 951 in Grand Rapids. “It isn’t just throw open the door and anybody who can marshal the money can get one.”

Saint Mary’s and Spectrum, meanwhile, agreed to work jointly on acquiring a PET scanner because their respective individual applications for separate units are headed for denial. The hospitals will likely appeal the rejections and seek to have their joint application reviewed on appeal once the new standards are in place.

The maneuver, Zwarensteyn said, will put Saint Mary’s and Spectrum near the front of the line when the state begins licensing new PET scanners.

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