Thoughts on Ultrasound

With South Carolinas' proposed ultrasound bill making headlines nationally, I thought I’d chime in on the business of ultrasounds in general...while the subject was still at arms reach. I feel uniquely qualified to comment on ultrasound since my better half operates an independent diagnostic testing facility, or IDTF, specializing specifically in the modality. Her facility offers both full diagnostics as well as 3D/4D limited diagnostic/elective ultrasounds.

Elective keepsake ultrasound facilities started appearing around the country in the late 1990’s, when ultrasound technology made the leap from grainy single-slice two dimensional renderings to volumetric three dimensional images that generated incredibly life-like images of babies in utero. We’ve all seen the commercials. These keepsake ultrasound places use the new 3D and 4D technology to provide expecting parents an exciting preview of their baby with detailed graphic image quality and motion.

My wife is an ARDMS registered sonographer and registered vascular technologist(RVT). She chaired the Diagnostic Medical Sonography program at our local community college, first as its clinical coordinator and then as the Program Director. She started the 3D-4D elective center three years ago. I wont hesitate to say that perhaps we viewed the world with rose colored glasses back then. The endeavor nearly broke us. The whole starting a business thing was exhaustingly hard work, and needless to say, although it has been what one would consider successful, it did not go as well as we had imagined it would in the sense that it failed to produce that elusive sense of fulfillment often associated with an entrepreneurial spirit. If you're a professional in the medical community in the Holy City you know that the community itself is holier than thou...both tight-knit and conservative by nature. So, for every minute of positive publicity she managed to generate, it was equally matched with two minutes of the negative variety. She only saw a handful of clients her first month despite aggressive advertising and a costly professional marketing campaign. She had essentially been black-listed by the establishment.

She started this business out of sheer passion and a love for the profession, and by stripping away the bureaucracy that has become ubiquitous in our health care delivery system, she could allow women access to the latest applications and technology while still maintaining a small, patient-focused atmosphere. After all, these services wouldn’t be available if there wasn’t a demand for them, and 3D ultrasound is truly a patient driven service. 2D ultrasound on the other hand, when operated by qualified sonographers is quite sufficient for obtaining clinical indications. Interestingly enough, very few CPT codes exist for 3D procedures, which means that reimbursements are the same for 2D as they are for its more desirable 3D cousin (desirable from the parent’s perspective that is).

So, for the short term at least, these entertainment businesses will thrive, and as well they should…because there is a demand, right? Not so fast. After three agonizing years in the elective ultrasound business, all the while kicking and scratching to preserve what was left of her professional image while fighting for every client, the handwriting was quietly etched on the wall. It is only a matter of time before the elective ultrasound industry is regulated completely out of business, but before that is allowed to happen, technology will catch up with it and drive the final nails into its coffin. I used this analogy with my son: "Why would you pre-order an x-box for $600 when you have a perfectly good play-station? You don't need the x-box, you simply want the x-box...and if you're patient, you can buy it next year for $350." The same holds true for these new ultrasound machines. Right now, Doctors don't need them, but as the technology advances, the new machines will become more affordable and rapidly replace the older units currently found in every OB-GYN office, thereby eliminating the demand for boutique ultrasounds altogether. In fact, there is convincing evidence that this trend has already began to manifest itself in the Lowcountry, and if you need further proof that self-refer is a tough row to hoe, take a look at what happened to Prevecare east of the Cooper a few years back.
My wife’s own company just purchased a brand new 3D ultrasound machine that is more portable, more powerful, and cost about half of what her first unit did…Now don’t get me wrong, it was still outrageously expensive, but my point is that they are now well within the reach of most private practices. Seeing that the handwriting was indeed on the proverbial wall, she felt it was time to start transitioning out of the elective ultrasound business and into the mainstream medical market. We needed to enroll in Medicare as a certified provider, begin accepting insurance, hire a physician, and contract with a radiology service to interpret the studies. She’ll still provide 3D ultrasound, it just means that we’ll be marketing to the doctors for referrals as opposed to marketing to the general public, but it also means an ADA approved facility, wider doors, wheelchair accessible ramps; grab rails, sinks in every exam room, the whole nine yards. More overhead? Absolutely. More regulatory oversight? Absolutely. Brighter future? Undoubtedly. One thing we will miss though is the 100% reimbursement we enjoy with the self refer work…a traditional provider only collects on about sixty percent of what is billed. Now I understand why they bitch so much.

So for all the moms-to-be out there seeking those keepsake ultrasounds...Do it the right way. Do it the safe way. Let your doctor know you want to have your diagnostic exam performed in a relaxing, patient focused environment, where the 3D pictures are complementary. He'll get a full report from our board certified in-state radiologist, we'll bill your insurance, and you can invite your family to share the experience. You'll leave with reassurance instead of a kitchen magnet and a false sense of security. We’ll keep you posted on the transformation.