Currently, cardiologists use machinesin their private practices, but Huckesteinspeculates that practices might revertback to the old trend: directing patients toa hospital for stress testing.“Reimbursement is now less than$100 — the national average,” he says.“We are seeing a new trend now wherethe primary care market is referringstress text exams to their local hospitalsor cardiology groups. When the marketwas favorable, we saw the opposite.Outsourcing is now the trend versusperforming these exams in-house. Thecosts just don’t justify the means.”“Our response to that is, ‘Hey,let’s give doctors what they want, andthat’s something less expensive,’” saysHuckestein.But Joe Avina of American InternationalMedical, a refurbishing company,says the trend toward mostly foreign secondarycompanies will be short-lived.“We’re already getting people onthe rebound,” he says. “They tried it andwant American.”Avina says the refurbishing marketis booming right now, as more andmore providers turn to less expensiveequipment; he says the average pricefor a refurbished PC-based systemis $12,000 to $15,000, and $5,000 to$9,000 for a traditional test.American International Medicalboasts a 40 percent increase in salesfrom last year, and it’s expected thatnumber will grow.“A major trend is huge growth inrequests for refurbished systems,” hesays. “I think it’s the economy.”But the passage of health care reformis also expected to drive sales inthe refurbished market, he explains.This could be attributed to the millionsof Americans who will receive healthcoverage under the new law.“[The health care law] seems tobe increasing activity tremendously,”he says. “I see it because we’re in thismarket. We’re going to benefit from thehealth care reform.”Correction boostsreimbursementThe Centers for Medicare and Medicaid(CMS) announced last month it wouldboost reimbursement for SPECT nuclearimaging by 16 percent. The increaseis a correction to the 2010 reimbursement,which cut nuclear stress testing to36 percent, according to a CMS report.“This is a very significant occurrence,perhaps among the most important,especially since Obama has becomepresident, as far as cardiologistsare concerned,” says Avi Soffer, CEOand vice president of University Nuclear& Diagnostics.The cut decreased from 36 percentto 20 percent, which will allow cardiologistssome breathing room, Soffer says.“[The 36 percent cut] was an unsustainableblow,” he says. “It’s a dealbreaker for the business.”Soffer points out that stress testingis the most effective tool for diagnosingcardiovascular disease (CVD) — thenumber-one killer in the country.“This modality is the only way tolook into the heart effectively, withoutcracking someone open,” Soffer says.A heavier populationmeans more businessAccording to the World Health Organization,more than 16 million people dieof CVD. <strong>Stress</strong> testing is considered thetop diagnosis tool for CVD and respiratoryconditions, which is “expected todrive revenue growth and investor interestsin the global [cardiopulmonarystress testing systems] market,” statesGlobalData, a market research company,in its Global Cardiopulmonary<strong>Stress</strong> <strong>Test</strong>ing Systems Market Analysisand Forecasts to 2015 report.In fact, the United States remains thelargest revenue generator within the globalCPST systems market; it’s expected togrow at a compound annual growth rateof 9.5 percent between 2008 and 2015, accordingto the report. That’s higher thanthe global average of 8.7 percent.Manufacturers and refurbishingcompanies aren’t surprised by this information.Both Avina and Buyukoglurecognize that heart disease related toobesity will cause an increase in theneed for stress testing.“One [trend] is linked to the richcountries’ obesity and diabetes, [whichis] still growing,” says Buyukoglu.“They represent all of the potentialcoronary diseases in the near future andwill need stress testing.”Over the last five years, the numberof indications for the prescription of aCPST test has almost tripled, accordingto the GlobalData report. The test is beingused as a diagnostic tool for more than10 clinical symptoms, whereas before,used mainly for assessment of cardiac orpulmonary function prior to surgery.<strong>Stress</strong> testing makesheadlinesIn March, Delaware resident MichaelFields was denied a cardiac stress testthree times. He ultimately underwentlife-saving quadruple bypass surgeryto clear an arterial blockage that wouldhave been found in a stress test and couldhave been treated in a less invasive way.<strong>Stress</strong> testing has been the subjectof insurance denials in Delaware by fourtop companies, including Aetna, BlueCross Blue Shield of Delaware, CoventryHealth Care and Cigna. The companies,which contracted MedSolutions toreview preauthorization claims, are beinginvestigated by Delaware insuranceCommissioner, Karen Weldin Stewart.The nuclear stress test, which usesthalium to show how well blood flowsto the heart, is much more accurate thanthe exercise stress test, says BarbaraAndrewin, an EKG clinical technicianat St. John’s Health Center in SantaMonica, Calif.“The nuclear stress test is more definitive,”she says.It’s 90 percent effective in diagnosingcardiac problems, says Andrewin.Andrewin points out that physicians“really don’t like doing [exercise stresstests] because [they’re] wasting a lot oftime,” when a physician knows the patient’shistory and knows the problem isheart-related.But that doesn’t mean the exercisestress test will become obsolete, as it isstill a key tool in ruling out heart problemsin healthy patients, says Andrewin.“I don’t think it will be phased out,”she says. “Doctors believe in them. Westill have healthy people that [think theyhave cardiac pain], but they’re havingGI problems…With that in mind, we’restill going to do regular stress tests.”DOTmedbusiness news I j u n e 2010 61
Something new in the sectorToday, companies are adding new testingfeatures to the exercise stress test,allowing them to perform multiple testsat once.One test in particular studies themicrovolt T-wave alternans (MTWA)phenomenon, which is an indicator of aperson’s risk for sudden cardiac arrest— a leading killer in the United States.“What’s new for stress testing is thatthe addition of microvolt T-wave alternanstesting may be the first significantchange,” says Ali Haghighi-Mood, CEOof Cambridge Heart. “[The addition ofMTWA testing] has the potential to introducea new standard for stress tests.”Cambridge Heart, based in Tewksbury,Mass., recently received FDA approvalto sell its OEM module that usesthe analytic spectral method of measuringMTWA. This particular method wasoriginally developed by the MassachusettsInstitute of Technology.Lahn Fendelander, CambridgeHeart’s vice president of clinical affairs,explains that the analytic spectral methodis patented by Cambridge Heart andthe only MTWA testing method that isMedicare-reimbursable.“The traditional stress test, in layman’sterms, is looking for a plumbingproblem — coronary heart disease,”says Fendelander. “The MTWA testlooks for an electrical problem…Byadding [the MTWA feature], if you doa stress test, you have assessment of theplumbing, and now you have assessmentof the electrical.”Cambridge Heart has teamed up withCardiac Science, a leader in stress testingequipment, to sell its MTWA modulewith Cardiac Science’s equipment.As far as trends go, other OEMssuch as GE and Burdick, also have anMTWA test, and the trend seems to begrowing.“Having [the test] as an OEM moduleon other manufacturer’s stress systemis one of our biggest goals,” saysFendelander. “So far, we’re movingpretty well with Cardiac Science, and tohave it on an existing stress system is animportant step.”Online: dotmed.com/dm12649•Heather Mayer can be reached by e-mail athmayer@dotmed.com.DOTmed Registered <strong>Stress</strong> <strong>Test</strong> Equipment Sales & Service CompaniesFor convenient links to these companies’ DOTmed Services Directory listings, go to www.dotmed.com and enter [DM 12649]Names in boldface are Premium Listings.Name Company - Domestic City State Certified DM100Michelle Booth Booth Medical Equipment Alexander AR•David Smith Smith Medical Equipment, Inc. Fort Smith ARKenn Matayor Jaken Medical, Inc. Chino CA•Phil Lonbeck DB Medical Electronics Diamond Bar CACraig Pelissier GTS Medical, Inc. Huntington Beach CA •Al Wright AKW Medical, Inc. San Diego CA Joe Avina American International Medical Sylmar CA• •Gordon Huckestein Cardiac Direct Ventura CARyan Davis Davis Medical Electronics, Inc. Vista CA• •Moshe Alkalay Hi Tech Int’l Group Boca Raton FL•Avi Soffer University Nuclear Diagnostics Davie FLClinton Courson Quest Medical Supply, Inc. Longwood FL•Stan Poole Medical Maintenance Consultants, Inc. Norcross GA Joe Murray Medeco Boise ID •Akhter Hussaini ALM International, Inc. Bensenville IL•Richard Fosco HealthWare, Inc. Oak Brook ILPhilips Healthcare Philips Healthcare Andover MA•Robert Gaw Jr. Physicians Resource Network Fall River MAAlda Clemmey Saffire Medical Taunton MA•Lahn Fendelander Cambridge Heart, Inc. Tewksbury MAJohn Gladstein Medical Device Depot Ellicott City MDZeina Karaky Cedars Medical Equipment Co. Dearborn MI•Gene McGorisk Gaingramco Livonia MIBob Caples Med-E-Quip Locators, Inc. Maryland Heights MO• •Jason Eden Bio Basics Global Park Hills MO •Steve Arey BEST of Rowan, LLC Salisbury NC•Roger <strong>Nasiff</strong> <strong>Nasiff</strong> Associates, Inc. Central Square NyMordy Eisenberg Absolute Medical Wesley Hills NY•Ben Holloway Southwest Medical Corporation Broken Arrow OK• •Rafael Contador MD Depot, Inc. San Juan Puerto RicoBulent Buyukoglu USmedevice, LLC Cumberland RI•Charles Tucker MedSurg Equipment, LLC Beaumont TX•Robert Valencia MMS Medical Solutions, Inc. Grapevine TXGene Nelson Southern Medical Equipment Sales & Service South Houston TX• •Dean Johnson BioTech Services, Inc. Edgerton WIEric D. Schwarz McLain Surgical Supply, Inc. Charleston WVName Company – International City Country Certified DM100Fernando Miranda Gemetek Santiago ChileToby Hu Edan Instruments Shenzhen ChinaEfthimios Tentolouris Tentolouris Trikala GreeceGregory Cherkassky ZZ Handasa Hashdod IsraelNesakkumaren Sivakumaran Primamed Technology Sdn Bhd Puchong MalaysiaShafee Sirat Pendawalima Technology Shah Alam Malaysia62DOTmedbusiness news I j u n e 2010www.dotmed.com
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