Why Pay More for Less?

Why is it so expensive to receive Cardiac CTA (CCTA) training?

The simple answer to this question is that it doesn’t – and overall shouldn’t – have to cost as much as is currently being charged by most facilities. The high costs of CTA training programs currently on the market has less to do with actual costs of training and much more to do with the desire of the entrepreneurs involved to make as much money as possible. And to my way of thinking, that’s okay. Simply put, it is supply and demand, and if it isn’t worth it, then don’t do it.

So what are the real costs involved in conducting Cardiac CTA training?

Beside the costs of the workstations, rent, utilities, and a small advertising budget and support staff, my biggest costs for CTA training are:

1.       The extra time it takes to assemble the cases and organize information in a coherent way – which is a lot of work but also a lot of fun!

2.       The same high cost of lost patient billing time, as is the case for course participants as well.

Beginning in 2005 when there was an initial high demand for training and reduced availability of training sites there were some very high charges for CTA courses. In some cases this was between $12 – 15,000 for level 2 training. Subsequently with the Deficit Reduction Act (DRA) and the Medicare and insurance company reimbursement cuts and restrictions, the potential for profitability of Cardiac CTA scanning fell and the enthusiasm and demand for training dampened. However, less demand has led to reduced CTA training fees. Eventually as the July 2010 deadline for grandfathered training gets closer, demand will increase again and prices may rise.

How low can and should the costs of training go?

Just like with stocks, the price of cardiac CTA training depends on the market place and consumer expectations and demand. It will also depend on the quality. If you believe, as I do, that Cardiac CTA scanning is a very useful technique and is here stay, then the short term bureaucratic limitations placed on the technique shouldn’t matter. CTA scanning will eventually be used and ‘rediscovered’ as being useful. In that case, learning the Cardiac CTA technique and how to incorporate it into one’s practice is an eventuality rather than a possibility. And learning how to ‘do it right’ becomes a necessity.

That being said, I have designed my cardiac and cardiac CTA (CCTA) training classes to offer the best quality training at the least possible cost anywhere. Based in a large private cardiology practice in beautiful Marin County, California, just north of the Golden Gate Bridge, my courses offer an enjoyable setting in which to work hard and thoroughly learn this new and highly valuable technique of Cardiac CTA. We are committed to quality, not just in our scanning protocols but also in the teaching. After working for over ten years with Dr. Doug Boyd, inventor of the EBCT scanner, which up until recently was the only cardiac CTA scanner available, my group several years ago finally incorporated MDCT scanning into our clinical practice. And we are making good money at it, too.

In 2005, after years of doing applications training for electron beam angiography (EBA) I saw the need for quality training in Cardiac CTA, and I began offering live, totally case-based training at our outpatient scanning center. I also opened a Cardiac CTA training center office in the building next to our office that is full of workstations and teaching materials with a small kitchen. When we are not in the scanning center we are across the street reviewing cases on the workstations and over the internet.  We provide a very relaxed setting in which to learn with small classes of five to ten participants including fellows. Our courses are small, focused, intense training in a busy but very enjoyable and relaxed setting in an extremely nice part of the world.

Our CTA scanning center is a joint venture, Stark compliant L.L.C. with our urology and oncology-cancer care group. We have two electro physiologists in our group who perform close to four hundred pulmonary vein ablation procedures yearly with spectacular results. (They are rated number three in the world by an independent firm). We also have three vascular surgeons and one cardiologist fully trained in peripheral vascular interventions. Hence, our center is very busy and routinely scans twenty or more patients daily for a variety of diagnostic reasons. We believe that the best way to learn Cardiac CTA is by watching and participating in a busy scanning center like ours.

Training in cardiac CTA (CCTA) has a steep learning curve. While workstations have gotten progressively quicker and more accurate in their ability to process very large data sets generated by a full CTA study, in the foreseeable future they will not attain a level that will be free of artifacts and, inherent from that, prone to misinterpretation by the untrained or poorly trained eye. Thus, there can be no substitute for learning the fundamentals of Cardiac CTA and knowing full well how artifacts are generated and propagated. The minimum requirement for attaining competence at processing and interpreting Cardiac CTA has been published in the joint ACC-ACC statement on training. The bottom line on Cardiac CTA training is that it requires lots of hands-on-the-mouse training with a mentor who is skilled in all aspects of image acquisition, information reformatting and data transfer, as well as with image processing, reporting and storage.

And as I said, there is absolutely no substitute for watching and participating in a busy Cardiac CTA scanning center like ours for really learning how to do Cardiac CTA and how to best incorporate it into your clinical practice. At our training center you are always welcome to come back for a very reasonable fee, and if you really are not satisfied with your training, I am committed to providing free training until you are. I see Cardiac CTA training as a shared commitment to excellence and one that does not end with having just met the minimum requirements.

So, finally, why should you pay more for less to get this training? If you do, then that is your choice. But you should know the alternatives and in the end decide and take advantage of what works best for you. I really enjoy teaching, but I also really most enjoy taking care of patients. And there is no greater joy in medicine than using a new and innovative technique like Cardiac CTA to take better care of one’s patients. And as prior participants can tell you that have taken my classes, I will always look forward to sharing this same excitement with you.

James R. Adams, MD, FACC

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