title: Impact of Reimbursement Cuts on the Sustainability and Accessibility of Dopamine Transporter Imaging.
abstract: OBJECTIVE
  Dopamine transporter single-photon emission computed tomography imaging utilizing iodine-123 ioflupane is accurate for differentiation of Parkinson disease from essential tremor. This study evaluates how reimbursement for I-123 ioflupane imaging changed between 2011 (year of FDA approval) and 2014 (year after loss of pass-through status for hospital-based outpatient imaging from CMS).
  
  
  METHODS
  I-123 ioflupane reimbursement data for our institution's hospital-based imaging were compared between two periods: (1) July 2011 to October 2012, and (2) 2014. For each time period separately and in combination, averages and ranges of reimbursement for private insurance and CMS were analyzed and compared. A model to ensure recouping of radiopharmaceutical costs was developed.
  
  
  RESULTS
  Review yielded 247 studies from July 2011 to October 2012 and 94 studies from 2014. Average reimbursement per study fell from $2,469 (US dollars) in 2011 to 2012 to $1,657 in 2014. CMS reduced average reimbursement by $1,148 in 2014 because of loss of radiopharmaceutical pass-through status. Average reimbursements from CMS versus private payors markedly differed in 2011 to 2012 at $2,266 versus $2,861, respectively, and in 2014 at $1,118 versus $3,470, respectively. Between 2011 to 2012 and 2014, the CMS percentage increased from 54% to 78%. Assuming that I-123 ioflupane cost $2,000, our model based on 2014 data predicts a practice with greater than 60% CMS patients would no longer recover radiopharmaceutical costs.
  
  
  CONCLUSIONS
  Reimbursement levels, payor mix, scanner location, and radiopharmaceutical costs are all critical, variable factors for modeling the financial viability of I-123 ioflupane imaging and, by extrapolation, future radiopharmaceuticals.
authors.affiliation: Banner University Medical Center Tucson, Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Covington
authors.affiliation: Banner University Medical Center Tucson, Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Natalie A
authors.initials: NA
authors.lastname: McMillan
authors.affiliation: Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona College of Medicine, Tucson, Arizona. Electronic address: pkuo@radiology.arizona.edu.
authors.forename: Phillip H
authors.initials: PH
authors.lastname: Kuo
mesh_terms: D001130:Arizona / Q000453:epidemiology; D003362:Cost-Benefit Analysis / Q000191:economics*; D050483:Dopamine Plasma Membrane Transport Proteins / Q000378:metabolism; D017048:Health Care Costs / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D006278:Medicare / Q000191:economics; D018803:Models, Economic; D057054:Molecular Imaging / Q000191:economics / Q000706:statistics & numerical data; D009662:Nortropanes / Q000191:economics*; D010300:Parkinson Disease / Q000000981:diagnostic imaging* / Q000191:economics*; D015397:Program Evaluation / Q000191:economics; D019275:Radiopharmaceuticals / Q000191:economics; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States
chemical_list: D050483:Dopamine Plasma Membrane Transport Proteins; D009662:Nortropanes; D019275:Radiopharmaceuticals; C519528:ioflupane
keywords: Dopamine transporter imaging; HOPPS; Medicare reimbursement; imaging access; ioflupane; radiopharmaceutical cost