Finding new and innovative ways to cut costs and optimize operations has always been a priority, but priority turns into necessity in a tight economy. DOTmed spoke with University Nuclear and Diagnostics COO and Senior Vice President Avi Soffer to get a glimpse of how UND helps nuclear stress test labs save money and improve operations while providing better patient care.

Nuclear stress testing is considered the number one income producer for many if not a majority of cardiologists. For being such a critical revenue driver, many stress test labs and internist practices are still rife with inefficiencies, says Soffer. This is exactly what the founders of Florida-based UND realized before establishing the consulting and service-oriented business eight years ago.

"Stress testing has been the gold standard for detecting heart disease for 20-something years. It's a life saver," says Soffer. "We help facilities perform better for their communities and that is a win-win scenario."

UND came into being in 2001 after a few private consultations grew into a solid business model with lots of opportunity for expansion. One of the cofounders and now CEO, Armando Clavero, was a certified nuclear technician for 17 years and attended medical school in Spain. The company was originally located at Memorial Regional Hospital in Hollywood, Fla., but rapid growth prompted a relocation to a new 5,000-square-foot facility in Davie, Fla.

With a 52-point checklist and thorough analysis of equipment, expenses, staffing and scheduling, UND determines accurate cost per test and streamlines operations. With the implementation of new procedures and trained personnel, UND has been able to cut facilities' operating costs by 20 percent, and in "extreme cases" up to 40 percent. UND is now national and has performed practice assessments in 12 states across the country.

The Services

The company's top selling services are packaged as SmartLab and CompleteLab. Organizations seeking to overhaul or add a brand new nuclear stress test lab to their facility would choose CompleteLab, a turn-key solution including trained technicians and equipment. UND can bring in new or refurbished equipment within three days and offers all the big names in gamma cameras, including GE, Siemens and Philips. The service covers everything from initial licensing to employee badges.

SmartLab is a simplified version of CompleteLab and focuses on improving the efficiency of existing operations. UND does a rundown on everything from the cost of medical isotopes to labor, including nuclear physicists, cardiologists, and technicians and finds ways to cut cost without cutting care. UND retains a well-trained team of nuclear technicians who go from practice to practice or the company may hire somebody specifically for the facility, depending on their needs.

"Sometimes we even train their staff and they retain complete control," says Soffer.

A major drain on many nuclear stress test labs is inefficient scheduling. If a patient doesn't show up the practice suffers and more so for nuclear stress tests than for many other procedures.

"Scheduling is a big issue," says Soffer. "On average two out of 10 people will not show up for their exam. The radioisotope decays and the practice takes up the bill."

UND has come up with administrative best practices that help labs improve communication with patients thereby encouraging appointment attendance.

Serious Cost Savings

Soffer estimates that facilities' cost per cardiac stress test ranges between $200 - $500 depending on the practice. The average cardiologist performs about 1,000 tests annually. UND's customers often save enough money to invest in state-of-the-art equipment upgrades or they open satellite centers that provide additional revenue.

"We would get calls from various practices saying 'we did so well this year that we want to open another office,'" says Soffer. "This has led to exponential growth for UND."

As it stands, UND has a 100 percent customer retention rate and an impeccable retention rate for their staff, including technicians.

Moving Away From Mobile

Mobile stress test labs can charge upwards of $2,500 a day. That's about $410 per test at a maximum of six tests per day, according to UND. Many health care centers, especially those in rural communities, do not have the volume to warrant the cost of calling in a mobile unit multiple times each month. UND can come into a hospital and set up a dedicated CompleteLab and that practice can start performing as many as 40 tests per month with full ownership of all the equipment.

This is a growing market in rural areas, where practices have to refer patients out to more urban centers or local facilities that own equipment. Hospitals lose money when patients who are referred elsewhere choose to leave altogether, which is often the case, says Soffer. Setting up a dedicated stress test lab could provide a new source of revenue for rural hospitals.

On the Horizon

There is no end in sight to UND's success, especially if nuclear stress tests are sheltered from upcoming health reform, which Soffer suggests. All this groundwork has led to some new developments for the company, including movement into ultrasound labs. Another possibility for the company's CompleteLab package is the addition of positron emission tomography (PET).

"We offer just SPECT right now, but we may move into other areas of nuclear medicine," says Soffer. "We are eyeing PET very closely."

UND's rapid growth has also caught the attention of OEMs. With UND's continued success on their radar, the largest OEMs are beginning to inquire about exclusive contracts.

"The OEMs have contacted us and almost across the board they have pointed out that we seem to have complementary business models. We are in talks and we're extremely excited to see what, if anything, comes out of it," Soffer says.