The sudden death of 33-year-old St. Louis Cardinal pitcher Darryl Kile shocked a stadium full of Cubs fans two years ago. It also caused the phones to ring off the hook at Heart Check America, a company that sells $400 coronary scans directly to consumers through ads on the radio.
Only a few years ago, Heart Check and a growing group of competitors had a booming business selling powerful X-rays known as CT scans to the "worried well," former smokers anxious about lung cancer, those with family histories of heart disease and a certain percentage of hypochondriacs.
But now the heart- and body-scanning industry is on life support, and some health-care experts are predicting it may disappear.
Several scanning companies already have gone out of business, including CT Screening International and AmeriScan, an Arizona firm that advertised heavily in Chicago before closing its doors last fall. Rush University Medical Center got out of the business April 1.
Industry leader Heart Check America is hurting, too. Not even the recent heart attack death of James Cantalupo, McDonald's Corp.'s chief executive, caused a visible uptick in calls to schedule appointments.
"Most people can't afford it, and most people aren't really aware of it," said James Garvey, managing partner of Schroder Ventures Life Sciences, a health-care venture capital firm in Boston that looked at the body scanning industry and took a pass.
Garvey and others think they know the problem: The business model is terminally ill.
By bypassing the doctors who send patients for tests, the scanning industry made a strategic mistake, health-care experts say. Many doctors discouraged patients without symptoms from having heart and body scans, and some physicians became angry when they were asked to read the scans.
Without a doctor's approval, insurance companies refused to cover the screenings. The Food and Drug Administration warned healthy consumers against full-body scans because of the radiation dose.
Lacking a steady stream of patients referred by doctors, many scan centers simply didn't do enough scans to cover their high fixed costs.
"The model collapsed because it was not wholeheartedly endorsed by the medical community. At the very best, it was controversial," said Dr. Jonathan Berlin, a radiologist with Evanston Northwestern Healthcare.
Berlin, who examined the economics of free-standing scanning centers as part of an MBA class at the Kellogg School of Management, uncovered an additional problem: lack of repeat business.
"If everything is normal, they're not going to come back," Berlin said.
Bruce Friedman, Heart Check America's president, thinks the industry's problems are more recession-related than chronic.
"What we do is paid for with discretionary income. As that has decreased, so has our business," he said.
Undercutting the recession argument, however, is the success of the laser vision-correction industry, which is structured much the same way. It has continued to thrive during a struggling economy, industry experts say, because it provides an immediate, tangible benefit to consumers who want to ditch their glasses or contact lenses.
Friedman insists the industry shakeout is not a comment on the value of heart scans, which are gaining increasing acceptance in the medical community for effectively detecting early-stage coronary disease. In fact, cutting-edge spiral CT scans are becoming so good they may replace the invasive angiogram as the gold standard for diagnosing arterial blockages, some health-care experts say.
But even that may not be enough to revive the flagging industry.
A decade ago, the idea sounded brilliant.
Entrepreneurs would buy or lease a state-of-the-art CT scanner, set it up in a shopping mall or strip-mall center, then market via radio to affluent, health-conscious consumers.
Customers would book appointments through a toll-free number and pay anywhere from $350 for a heart or lung scan to $1,500 for a "full body" scan with cash or credit cards. No dickering with insurance companies or waiting for reimbursements.
Scan results with some statistical analysis would be mailed to customers, who would take them to their own physicians for interpretation.
For years, it worked, especially when a celebrity such as Oprah Winfrey had a body scan in 2000 and talked about it on her show or when somebody famous dropped dead of undetected heart problems.
"When John Candy died, every 300-pounder in the Chicago area called," said Friedman, whose company has 10 scanning centers around the country, including one in Arlington Heights and another at the University of Illinois Medical Center in Chicago.
A painless scan that took five minutes turned out to be a major turning point for Robert Jackway, a Rosemont financial planner in his early 40s who was experiencing such severe shortness of breath that his company gave him a parking space near the front door.
Two doctors had diagnosed asthma and assured him it had nothing to do with his heart, despite a family history of early heart attacks.
Jackway grudgingly agreed to a heart scan after being nagged by his wife. He was surprised to find out he had more coronary plaque than 86 percent of people his age tested at the center. But when he took the results to his physician, Jackway got a tongue lashing.
"He said, `Oh, Bob. You didn't pay for this. These tests are terrible. They are alarming people unnecessarily,'" Jackway recalls.
Eventually, a stress test and angiogram confirmed the diagnosis of a blocked artery. Jackway had an angioplasty to widen the narrowed vessel, and a stent was inserted. Suddenly, he could breathe again.
Jackway is such a believer that he did a testimonial ad for Heart Check without being paid.
Some doctors are converts as well.
In Chicago, 20 percent of Heart Check patients now come from physician referrals. That number is 90 percent in Los Angeles, where Heart Check stopped advertising in late 2001.
"Fortunately we've been able to adjust," Friedman said.
Dr. Kenneth Breger, an internist in Highland Park, recommends Heart Check coronary scans to two or three patients a week.
Sometimes, they are relatively young men with atypical chest pains. Sometimes, the patients have a strong family history of heart disease.
"I'm a big proponent of them," Breger said. "It's not a test that is uniformly respected by cardiologists, but it is foolish not to take advantage of this technology."
About half the patients he sends to Heart Check for scans are found to have some plaque buildup in their arteries, an early sign of heart disease.
But miraculous stories like Jackway's are the exception.
Scans of healthy people often find nothing, or worse, they find something that isn't a problem but creates anxiety for patients anyway.
Abdomen and pelvis scans have come in for the most criticism because they sometimes discover very small tumors or abnormalities that turn out to be completely benign after further invasive testing.
The chance a man age 40 to 60 has malignant kidney cancer at the time he undergoes a scan is 1 in 20,000, Dr. Stephen Baker, chairman of the radiology department at the New Jersey Medical School, told The New York Times magazine last year.
Even as the scanning industry takes a turn for the worse, a hybrid business model known as an imaging center shows growth at a healthy clip.
There were 2,188 free-standing imaging centers in the U.S. in 1993, according to Verispan, a health-care information company. That number more than doubled to 4,773 by 2002.
A free-standing imaging center is likely to have a CT scanner just like a body scanning center. But it also may have an open MRI, an ultrasound machine and equipment to perform digital mammography.
There's another key difference: The vast majority of an imaging center's patients come from doctor's referrals, not walk-in customers.
Take Medical Imaging of Northbrook Court, a free-standing imaging center owned by Dr. Richard Mintzer, a radiologist, and a group of private investors.
Of the 10,000 exams performed last year, only about 800 were not ordered by a doctor. That means fewer than 10 percent were paid for directly by so-called walk-in customers.
Many of those were virtual colonographies, a $795 scan that insurance companies don't cover but some people are willing to pay for to avoid the more invasive colonoscopy.
Even with the steady stream of patients from area doctors, building a profitable business has been hard work, said Mintzer, who opened his imaging center two years ago.
"The reality is there are a ton of these centers out there. It takes a while to turn the corner," he said. "If you're looking for a fast buck, this isn't the way to do it." |
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