In healthcare, as in baseball, you gotta have heart...miles and miles and miles of heart.
And that's why imaging technology that electronically scans coronary arteries has marketers, hospitals and physicians buzzing like those good old days of go-go, fee-for-service medicine.
Only in 1996, sticky issues such as technology assessment, insurance reimbursement and the cost-effectiveness of preventive medicine will help determine whether cardiac scanning is destined to become healthcare's Next Big Thing.
Proponents say the technology, Ultrafast Computed Tomography, is a useful tool for detecting heart conditions before they develop into serious cardiac problems. They claim Ultrafast CT is a much stronger predictor of coronary disease than stress tests or measuring cholesterol levels.
Cardiovascular disease remains the nation's numero uno cause of death. An estimated 1.5 million Americans will suffer a heart attack this year, and in 150,000 of the cases, the first, last and only symptom of their heart disease will be a fatal grabber.
It's the high cost of cardiac medicine that has healthcare providers and insurers taking a hard look at the technology. The American Heart Association estimates that more than 60 million Americans are afflicted with some form of cardiovascular disease and that more than $150 billion is spent annually diagnosing and treating heart problems.
Moreover, aging baby boomers seem to have an obsession with health, fitness and staying active as they head into their second 50 years. That bodes well for the medical marketers who are attempting to goose consumer interest in Ultrafast CT.
The noninvasive procedure, which scans 20 times faster than conventional CT technology, snaps pictures of the pumping heart that can highlight calcium in the coronary arteries. The calcium is a signal of plaque buildup inside the artery walls, which can trigger angina, heart attack or stroke.
Supporters of the technology are counting on HMOs to begin approving the heart scan as a way to identify cardiac risks of middle-aged enrollees, especially those with family histories of heart disease. Although the 10-minute test typically costs about $400, the devotees note that most insurance plans readily pay for stress tests costing $300 and up. Most insurers are carefully evaluating the cost and benefits of the procedure.
The June 1996 issue of the American Heart Association's Circulation magazine concluded that Ultrafast CT "is more powerful than the best available noninvasive test in predicting heart attack and other disease episodes, even in apparently healthy people."
But critics point to the nearly $2 million cost of investing in the technology, which is manufactured by San Francisco-based Imatron with most marketing/distribution handled by Iselin, N.J.-based Siemens Medical Systems. And while initial Ultrafast test results look promising, skeptics want more data.
Imatron began selling the scanner in 1984, but the coronary artery application is a recent phenomenon that has propelled interest in the technology. The company says 65 of its scanners are operational worldwide, including 32 in the United States at such leading institutions as Mayo Clinic, National Institutes of Health and University of California Los Angeles Medical Center.
Imatron also owns nearly half of HeartScan Imaging, which operates centers in Houston, Pittsburgh, San Francisco and Seattle. In addition to the $400 Ultrafast scan, HeartScan patients can pay another $100 for blood pressure, cholesterol and triglyceride (fatty acid) testing.
In the Chicago area, a marketing skirmish has broken out between University of Illinois at Chicago Medical Center, which operates under the HeartCheck America banner, and Advocate Health Care, which offers the LifeTech program at its High Tech Medical Park in south suburban Palos Heights.
LifeTech is marketing primarily to physicians, while its competitors at UIC's HeartCheck America focus primarily on the consumer. HeartCheck America, for instance, stresses confidentiality and says the patient decides whether the physician or insurer will have access to the results. It even has the handy-dandy reservation number of 1-800-NEW-TEST.
"In this day and age of denials of care, skyrocketing premiums and patient enlightenment, it makes sense for people to know about their medical risks," said Richard Saunders, HeartCheck America's general manager. The Los Angeles-based company manages sites in Chicago, Pittsburgh's Mercy Heart Institute and at UCLA.
On the other hand, LifeTech banks on physician referrals and makes it clear that a copy of the results will be sent directly to the physician, who then explains it to the patient.
LifeTech, founded by former hospital administrator Perry Witkin, manages the Advocate site but owns a scanner facility in Nashville, Tenn. The company will open centers in South Bend, Ind., and Atlanta by year-end and is working on development deals in four other cities.
Allan B. Zelinger, M.D., director of echocardiography at Advocate's Christ Hospital in Oak Lawn, Ill., reads reports for LifeTech and is guardedly optimistic about the Ultrafast technology.
"I'd like to see more studies, but I've liked what I've seen so far," he said. "Going over the test with patients really does help. It's one thing for a primary-care physician to go over risk factors and recommend lifestyle changes. But when a patient and physician are discussing actual images, it's a much more powerful message."
When it comes to Ultrafast CT, Jim Dunfee is not concerned about reimbursement issues or the lack of clinical studies.
Frankly, the 45-year-old South Bend real estate broker is just thankful for the wake-up call he received in May after taking the test at UIC Medical Center.
Dunfee decided to sign up for the HeartCheck America test after one buddy dropped dead at the health club and another at his son's hockey game. His father's history of heart problems cemented the decision.
Dunfee's results showed major plaque buildup. Within a month, he underwent successful six-way bypass surgery at Memorial Hospital of South Bend. Now, he's a true believer in the technology and a poster boy for HeartCheck America's aggressive advertising campaign.
Since the operation, the burly Dunfee has dropped 33 pounds from his 6-foot-1-inch, 250-pound frame and converted to a strict vegetarian diet.
"Thanks to the test, I've completely changed my lifestyle," he said. "It gave me a second chance at a long, healthy life. I can see the day when the procedure is as routine as mammography is for detecting breast cancer."