GE VScan and Handheld Ultrasound Devices   9 comments

Why an amazing product can’t find a market

The Gold Standard: GE Vivid 7 (Courtesy GE Healthcare)

Medical ultrasound is considered one of the most effective imaging modalities for cheap, reliable diagnosis of many disease states from heart disease to infected abscesses. Since the technology’s inception, device manufacturers have been steadily miniaturizing components so that what used to be a desk-sized machine (The GE Vivid7 in the picture to the left is a modern version of these behemoths) has now been succeeded by a laptop bolted to a small rolling cart with a number of ultrasound probes hanging off the side.

In late 2009, GE Healthcare released its VScan (see picture on right) handheld ultrasound device to the American market. The VScan device was most notable for its size — only slightly bulkier than a classic clam-shell mobile phone — and a price that was 80% less than traditional machines. Although VScan’s introduction was accompanied by a number of competing devices from other major industry competitors (e.g., Siemens’ ACUSON P10, Signostics’ Signos) as well as enterprising start-ups, the VScan has generally been considered to be the superior product in the pocket portable product segment because it functions near-identically to larger laptop-based portables but in a smaller form-factor. (Still not quite following? See a short introductory video by GE here.)

GE VScan

GE VScan (Courtesy GE Healthcare)

The VScan’s entry should have been heralded by doctors in a variety of clinical settings. A device exists that a clinician can carry in his or her pocket that with relatively little additional training can be used to detect traumatic injuries, major vessel disease, heart failure, and other maladies all without the need for any further appointments (in the outpatient setting) or bulky equipment often confined to a poorly accessible imaging suite. Unfortunately, the VScan and its competitors have had little adoption in the years since their introduction.

The lack of interest in the VScan illustrates how the current reimbursement system of the American healthcare system has direct effects on how patient care is provided. An example of these skewed incentives can be readily seen in one of ultrasound’s largest markets – outpatient cardiac ultrasound. Without VScan, a cardiologist orders a comprehensive ultrasound study that typically requires a second visit and an advanced cart-based ultrasound machine. Each study performed earns the cardiologist a professional and technical fees exceeding $1,500. In contrast, current reimbursement policies (typically set by Medicare and then voluntarily adopted by private insurance companies) do not cover ultrasound procedures performed with handheld devices so physicians are unable to charge for this service. Thus, the $7,000 cost of each handheld ultrasound machine is not going to be recouped through additional procedural charges.

The only revenue stream from use of the VScan product is any potential efficiency gains met by being able to rule-out serious underlying disease quickly and thereby see more patients in the same amount of time. While such a hidden benefit may be difficult to convey to a private practitioner or a standalone healthcare system, integrated healthcare systems (e.g., U.S. Veterans Affairs Hospital Systems, National Health Service) stand to benefit more from lowering the number of unnecessary comprehensive ultrasound exams. It should be no surprise then that integrated healthcare systems in Europe have been some of the few markets where handheld ultrasound devices are regularly used and clinically studied.

Personally, I’m not convinced by proponents of the VScan that such devices will soon replace the conventional stethoscope. The price and relative ease of use the latter are so superior that any real competition between the two is still a decade or more away. Such a claim is analogous to saying the typewriter would make the pencil obsolete. What is far more likely is growing demand for VScan and its competitors as the American healthcare system wakes up to cost-effective care. A greater focus on comparative cost-effectiveness will lead to reimbursement policies rewarding physicians for at least the limited use of such handheld devices versus comprehensive ultrasound studies. As GE’s marketing efforts in the ultrasound industry demonstrate, the real success of such a product can only be evaluated as a component of a greater imaging ecosystem. For a GE, the real value of such a device is that it allows the company to offer an end of the spectrum poorly matched by any of its competitors.

Conflict of Interest Disclosure: I have never received funding from and have no financial stake in GEHealthcare or its subsidaries. In 2010, GEHealthcare loaned a LOGIQ i portable ultrasound machine to a humanitarian surgical trip I led to Hinche, Haiti.

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9 responses to “GE VScan and Handheld Ultrasound Devices

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  1. Pingback: Is the independent medical device industry dead? « Blue Oceans for Health

  2. The professional fee for an echocardiogram is about $ 60, not $ 1500. The latter is an entirely incorrect, and frankly absurd, number.

    • Dr. Die caught a point needing clarification (and edit to the original post). The professional AND technical fees per study amount to $1,500 (source: Dr. Eric Topol at the Scripps Translational Science Institute, http://www.theheart.org/article/1248557.do). Importantly, this further elucidation does not change the argument presented above. A cardiologist “earns” for a practice with in-clinic ultrasound machines $1,500 for the completion of a comprehensive echocardiogram. This revenue still represents a huge disincentive to the use of a handheld device that does not receive reimbursement.

  3. On the GE website reimbursement amounts, etc. are explained. However, it seems as it you cannot charge for an U/S done during the visit for the problem at hand. So in other words, if a pt. comes in with RUQ pain and you perform an US of the GB, you cannot charge for the visit and the U/S. Is that correct as far as you know?

    • For the sake of practical billing questions, perhaps others with more experience treading those perilous waters can offer more nuanced advice. My limited understanding of the reimbursement specifics is exactly as you stated. Whether because of real legal issues around billing or simply out of regulatory terror, the current handheld user is not able to bill for the exam/visit and bill the professional fee for interpreting the ultrasound.

  4. Spot on with this write-up, I truly think this website needs much more consideration. I’ll probably be again to read much more, thanks for that info.

    Michelina Schwartzkopf
  5. I discovered US 2 years ago. The afordable price of GE Vscan allow me to buy an US equipment and practise US exploration in emergency room and general practice. I don’t charge my explorations but my work is more interising now . I’m making videos of my interesing clinicals cases in Youtube.
    http://www.youtube.com/user/girardphilippe1?feature=watch

  6. Pingback: Year in Review – Best of 2012 « Blue Oceans for Health

  7. I am an Obstetrician very much interested in how this unit could improve my delivery of care but the inability to recoup for the time/service would make it financially self destructive to buy. I agree that the reimbursement system does drive what and how such technologies are employed.

    Wm David Moore MD

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