Recently I have had a few patients and families email or tweet me questions about the inability to have a PET-CT exam ordered on a timely basis.
Challenge: 1. Why do I have to have multiple imaging exams and biopsies performed before my physician will order a PET-CT? 2. Why does it take so long for me to get a PET scheduled and have the exam performed?
To answer the first challenge, there are fundamentally a few items that encourage physicians and healthcare systems to work in this manner.
First is the potential risk of radiation exposure to patients. In order for a PET scan to be performed, patients need to be injected with a radioactive sugar called FDG. (click this link to learn all about PET and FDG) If the PET is combined with a CT Scan, there is also additional radiation exposure from the CT Scan too.
The second risk is financial. If a patient does NOT have a pathological diagnosis of cancer, and one that is not on the CMS coverage guidelines, than the exam will not be paid by insurance companies, and the patient may be responsible for payment. (here is the CMS list) This could be a few thousand dollars to close to $10K depending on where you are located and the charge code master.
The other item that impacts this decision making process are clinical guidelines. When one refers to NCCN, ASCO, or other types of clinical guidelines and patient workup specific to cancer, it has been a guiding principle to have a pathological tissue diagnosis of cancer before moving onto a PET scan that will show how active it is in a patients body.
All of the above could be due to trying to limit the risk of exposure to unnecessary radiation exposure, patient safety, financial risks, or even litigation.
When trying to answer why it takes so long to get an appointment, again, it could be due to some of the factors above, but it could also be related to a few other items.
Hospitals or imaging centers may not always have access to enough FDG to schedule patients 8 or more hours a day, 7 days a week. FDG is a radioactive sugar that decays over time. It typically needs to be shipped and transported to a hospital, facility, or center that can properly handle, store, and then inject patients with the radioactive sugar. Depending on the distance and time, organizations may not be able to have a lot of FDG shipped to meet the potential demand.
Simply, by the time the FDG is shipped, received, and by the time a patient could be scheduled for an appointment towards the end of a normal day, the radioactive sugar may not have enough activity to deliver a meaningful scan.
Another reason may be the fact that not all hospitals, healthcare organizations, or imaging centers may have their own PET or PET-CT scanner. Other healthcare organizations have not wanted to make the financial investment in a PET Scanner and they contract with a mobile imaging provider. Depending on their contract and number of patients that they think will need to have a PET ordered as part of their workup, the scanner may only be there 1 or 2 days a week.
If there happens to be an increase in the number of patients diagnosed in a particular week, and they all are having a PET ordered, then it may impact when you are able to have your own PET exam scheduled.
Again, it takes a team to be able to deliver this to patients. It takes radiologists, nuclear medicine technologists, nurses, and many other clinical staff to prepare and administer the exam to patients.
As always, this is not the only set of reasons. Inside of healthcare there are always a numerous set of stakeholders and various decisions that need to be made, but I wanted to highlight some of the information behind a few of the actions you may be experiencing.
I think the most interesting question for the future may be as follows: As consumers and patients become more knowledgable on the information different imaging exams generate, and as they have closer communication with radiologists, will there become a point in time when a patient/consumer may have the power to decide that they want a PET performed earlier in the screening/diagnosis pathway because they want a simple YES or No answer to if they have cancer or not.
Time will tell the future story of consumerism as it relates to patients and PET Scans.
As always, you can feel free to contact me at: CANCERGEEK@GMAIL.COM or follow me on twitter @cancergeek
~CancerGeek#PtExp #PX #cancer #hcldr #hccosts #hcsm #stories #storytelling #lcsm #bcsm #hcmktg #mktg #storyteller #hcbiz