by Sean Ruck
, Contributing Editor | June 11, 2021
From the June 2021 issue of HealthCare Business News magazine
Some of the things we’ve been working on I want to continue to work on. The overarching issue, broadly, is making sure patients have access to innovative radiopharmaceutical diagnoses and radiopharmaceutical therapies. That access means you have those radiopharmaceuticals properly reimbursed, that there’s a workforce that can deliver these agents, that there are sufficient cameras and instrumentation for this, that the payments for the procedures are appropriate, and that historically underserved populations have access.
Within that, some of the emerging areas: I think we’ll see new diagnostic agents approved for prostate cancer and therapies. It will be very important to help roll those out and make them available. We’ve also had some major focus on the use of radiopharmaceutical dosimetry, to administer a precision dose to a specific patient. Another focus will be the responsible use of artificial intelligence in nuclear medicine. We have an AI taskforce, and they’re working on specific opportunities in nuclear medicine for AI. There’s no shortage of opportunities.
HCB News: What are the biggest challenges facing members today?
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Having sufficient reimbursement for some of our innovative radiopharmaceuticals and procedures is critically important. If it costs a hospital more to buy a radiopharmaceutical than you’re paid for it, it’s not a sustainable model. Regrettably, that’s the model we’re living with right now, with what they call a loss of “pass-through reimbursement” on innovative nuclear medicine diagnostic agents. So I’d say if you get the finances to work, then access would be there for patients. If there’s a realistic reimbursement for what we do, that would ensure the providers and technical staff are available and investments in nuclear medicine are made by hospitals. That is the challenge — if you don’t get paid, it’s hard to offer technology.
HCB News: Is there any other country you might point to as far as doing things better, doing things right with covering reimbursements?
Every country has its own peculiarities, but unfortunately, the availability of certain radiopharmaceuticals in the U.S. has lagged behind others. I’d say Australia has done fairly well in terms of making some of the radiopharmaceuticals available. There’s probably better availability in some parts of Europe, but the rules differ by country. I don’t think anyone has anything like the U.S. does, where after two or three years, a diagnostic radiopharmaceutical that’s, let’s say, hypothetically, $3,000, has reimbursement drop by 70 or 80%. That’s unique to us and I think completely fixable.