Applications

Soldiers & Sailors Memorial Hospital proposes to expand and upgrade its Emergency Department, Rehabilitation Services, and Cardiology department.

CTAAB concluded there is need for the proposed renovation and reconfiguration:

• The project will improve function in the Emergency Department;
• The project will improve accessibility and function of a number of high-traffic services;
• The project will improve the facility’s infrastructure;
• Anticipated project date is third quarter 2009.

Rochester General Hospital proposes to provide in-house mobile lithotripsy in an existing operating room in the hospital.

CTAAB concluded there is no community need for the proposed lithotripter:

• The units that are currently available are not fully utilized;
• The proposed service would duplicate existing resources and increase community cost;
• There is no compelling evidence the proposed unit would provide improved quality of care.

Appeal:

• Following an appeal, CTAAB recommended approval of the proposed lithotripter for two half days per week:
• Extracorporeal shock wave lithotripsy appears to be the standard of care for treating kidney stones.
• No supply-induced demand is expected to result from the additional lithotripter.
• Concern regarding additional community costs is not significant.
• A mobile unit would allow flexibility in responding to demand.
• Anticipated project operational date is January 2009.

Rochester General Hospital proposes to add a 64-channel CT scanner unit in conjunction with the expansion of its Emergency Department.

CTAAB concluded there is need for the proposed 64-slice CT scanner:

• There is evidence supporting an institutional need despite the lack of community-wide need for additional CT scanner capacity.  Specifically, current RGH CT scanners are utilized beyond benchmark levels and additional growth in CT volume is reasonably anticipated;
• The need for the proposed unit is not premised on cardiac imaging;
• Anticipated project operational date is first quarter 2008.

University Cardiovascular Associates proposes to install a 64-slice multidetector CT scanner at its office.

CTAAB concluded there is no community need for the proposed 64-slice CT scanner.  There is adequate available community capacity of CT scanners capable of performing cardiac CT angiography

Strong Memorial Hospital proposes to add a 64-slice CT scanner and a 1.0T open MRI.

CTAAB concluded there is need for the proposed 64-slice CT scanner:

• There is evidence supporting an institutional need despite the lack of community-wide need for additional CT scanner capacity;
• The need for the proposed unit is not premised on cardiac imaging;
• Anticipated project operational date is first quarter 2008.

CTAAB concluded there is need for an open MRI unit at Strong Memorial Hospital (SMH):

• Certain classes of patients (obese, pediatric, ICU) would experience improved quality of imaging and improved safety with the use of an open MRI;
• There are few community alternatives to provide open MRI services to SMH patients;
• Anticipated operational date is first quarter 2008.

Cardiac CT Angiography:  Using CT scans to visualize coronary arteries has been receiving increasing attention.  Although insurers have considered this technique investigational, the published scientific evidence has been growing. 

Based on its review of the Technical Advisory Committee (TAC) report on Cardiac CT Angiography, CTAAB recommends to insurers that:

• Cardiac-related CT angiography by advanced CT scanners (CTA) should be accepted for insurance coverage.  Coverage should be limited, however:
• Cardiac CT angiography should be approved and reimbursed when careful clinical assessment by a cardiologist finds that the patient has a low to moderate pre-test risk of coronary artery disease and the test will resolve clinical uncertainty;
• Cardiac CT angiography should not be approved or reimbursed when the test is done for screening purposes;
• Cardiac CT angiography will only be reimbursed when ordered by a cardiologist.

Calcium scoring should be reimbursed when performed as part of a contrast enhanced cardiac CT angiography study which is otherwise clinically indicated;

• The quality of machine and training requirements of those interpreting cardiac CT angiography tests should be further evaluated by the insurers.
• Consistent with the TAC Cardiac CT Angiography Report, CTAAB has established as operating policies to:

• Review all requests for increase in the number of CT scanners.  As part of the analysis of such a proposal, review the ICD-9 or other diagnostic codes to determine if the current and/or projected volume of scans is justified only on the basis of cardiac-related procedures;
• Permit current CT providers to continue to replace units one-for-one with the level of unit they believe is appropriate.

Pluta Cancer Center proposes to add a second linear accelerator.

CTAAB concluded there is need for the proposed linear accelerator:

• While Monroe County facilities are utilized at benchmark levels, Pluta Cancer Center is over-utilized; its volume greatly exceeds benchmarks;
• Pluta Cancer Center is the only program in the region without treatment capacity redundancy, either on site or at an affiliated site, leaving its patients at risk of treatment interruption;
• Pluta Cancer Center is the natural service area for Southeast Rochester and Monroe County which have received less than average radiation therapy, compared with the local average adjusted for age/sex/race and cancer incidence (based on information provided by the New York State);
• The second linear accelerator is expected to be functional by April 1, 2008.

Strong Memorial Hospital proposes to add a facility with four exam/sleep rooms to accommodate the evaluation and treatment of sleep disorders in children.

CTAAB concluded there is need for the proposed expansion:

• Existing space is nearing its limits; wait times are long; and there is a backlog of pediatric patients needing sleep studies.
• Specialized pediatric staff, increased staff-to-patient ratio and pediatric-friendly environment promote quality of care.
• The anticipated project completion date is March 2007.

Strong Memorial Hospital proposes to add an electrophysiology lab and to replace and renovate an existing electrophysiology lab.  

CTAAB concluded there is a need for the proposed electrophysiology lab addition and renovations:

• EP patient volume is increasing as a result of new indications, aging of the population, and increasing referrals.
• The projected volume and time demand on the existing labs will exceed the present capacity.
• The anticipated project completion date is July 2007.

Nicholas Noyes Memorial Hospital proposes to open a 12-station chronic renal dialysis center in Geneseo.  

CTAAB concluded there is a need for the proposed dialysis unit:

• There is need in the region for new capacity.
• The proposed unit will increase geographic access for Livingston County patients.
• There is strong support from county government.
• The anticipated project completion date is June 2007.