EMMC, 3 others seek PET diagnostic tool

BANGOR – Eastern Maine Medical Center has asked the state to allow it to spend $2 million to $3 million to establish a positron emission tomography, or PET, center, where doctors would use state-of-the-art imaging techniques to diagnose cancer and other tissue abnormalities.

EMMC is one of four health care providers that have submitted letters to the Department of Human Services, which regulates the building of expensive new medical services. There are currently no PET centers in Maine.

In their initial letters of intent, the four applicants all said they wanted to create statewide services, said William Perfetto, director of DHS’ certificate of need unit, or CON.

While EMMC’s PET facility would operate from a fixed location, the three other applicants want to create mobile units. Because of the potential overlaps, Perfetto has asked each applicant to come back with a more defined region it would serve. The other three are Molecular Imaging of Portland, Insight-Premier Health of Farmington, Conn., and Alliance Imaging of Wilmington, Mass.

The CON office, which protects the public against new unnecessary medical services, has been dealing with some controversial proposals this year including a spate of cardiac catheterization lab requests and an application by Central Maine Medical Center to build an open-heart surgery center in Lewiston. Perfetto said he does not expect the same kind of rancor with the PET requests.

The newness of the PET technology allows CON to step back and create comprehensive guidelines for its use, Perfetto said. Dr. Timothy Clifford of DHS’ Bureau of Medical Services is looking at other states to see what guidelines have been implemented.

There is a generally positive view toward PET scanning in the medical community, Perfetto said. Doctors contacted by his office have been enthusiastic, and Medicare is looking to expand the use of PET, he said. Medicare reimburses for PET in conjunction with seven maladies, mainly types of cancer. As many as 20 more are under consideration for future reimbursement.

According to Maine Molecular Imaging’s letter of intent, PET imaging offers information that can’t be gathered with more traditional technologies such as CT scans and MRIs. “PET scanners produce images of the body’s chemistry or biological functioning so that illnesses such as cancer, cardiovascular disease and Alzheimer’s are seen at earlier stages,” it said.

Because the devices give such an advanced look at the spread of cancer, they help doctors to develop more specific treatment plans that can reduce costs by shrinking hospital stays, Perfetto said.

Sister Mary Norberta, CEO of St. Joseph Hospital in Bangor, said PET scans still need refinements when used for noncancer diagnosis. But she said PET is an excellent tool to identify tumors and to tell how they are responding to certain treatments. If a PET scan shows a patient’s tumor has not responded to one treatment, another treatment can be tried without an invasive diagnostic procedure, she said.

Because PET is such a good tool, St. Joseph Hospital signed a letter for one of the mobile providers saying that the services would be welcome. But, Norberta said, the hospital hasn’t chosen a particular provider. She said the determining factors would be the cost to patients and the quality of the equipment.

She said St. Joseph does favor mobile units simply because they can be moved to rural hospitals as needed. EMMC probably should have a fixed unit as well, because it has a need at its cancer center, Norberta said.

Despite agreement in the medical community, Perfetto warned that providers would have to demonstrate a genuine need for each unit they request. None of the providers proposing new services has yet filed detailed information, he said.

EMMC is working on developing its projections on how many patients would be served by PET, said P. Jerry Whalen, vice president for business development for Eastern Maine Healthcare, parent corporation of EMMC. The hospital already sends patients to Boston for PET scans. Sometimes a patient needs a follow-up within a few months, he said.

“Maine, in general, has fallen behind [on PET],” Whalen said.

State health care providers were cautious when PET came on the scene, Whalen explained. That was prudent. Similar care was exercised when CT scans first arrived and then when MRIs arrived, he said.

“Every generation [of equipment] has clearly had to prove its value to the diagnostic tool kit,” he said.

“Use of PET for clinical staging can indicate a different stage of cancer, saving some patients unnecessary surgery and indicating potentially curative surgery for some patients who otherwise would not have received it,” wrote Norman Ledwin, CEO of EMH, in a letter of intent to state officials.

Because of its cancer center, EMMC may have a strong case for a PET servic, Perfetto said.