“Publicly disclosing competitively negotiated, proprietary rates will push prices and premiums higher — not lower — for consumers, patients and taxpayers,”
Matt Eyles of AHIP in response to CMS’ latest effort to create real healthcare cost transparency. Safe to say, not everyone agreed with Eyles on this.
Imaging Wire Sponsors
- Carestream – Focused on delivering innovation that is life changing – for patients, customers, employees, communities and other stakeholders
- Focused Ultrasound Foundation – Accelerating the development and adoption of focused ultrasound
- Medmo – Helping underinsured Americans save on medical scans by connecting them to imaging providers with unfilled schedule time
- Nuance – AI and cloud-powered technology solutions to help radiologists stay focused, move quickly, and work smarter
- Pocus Systems – A new Point of Care Ultrasound startup, combining a team of POCUS veterans with next-generation genuine AI technology to disrupt the industry
- Qure.ai – Making healthcare more accessible by applying deep learning to radiology imaging
The Imaging Wire
SonoSite and Partners’ AI POCUS Partnership
Fujifilm SonoSite and Partners HealthCare launched a strategic collaboration to develop AI-enhanced point-of-care ultrasound technology. The collaboration will operate through the MGH & BWH Center for Clinical Data Science, while leveraging Partners’ data, computational infrastructure, and clinical expertise.
- First Up – Partners and SonoSite’s initial collaboration will target “some of the more complex” ED procedures with the goal of building ultrasound systems that can be used by non-experts to shorten diagnosis and treatment times.
- More Specifically – They’re focusing on developing AI-embedded ultrasound systems that can automate the segmentation of organ boundaries, measure anatomic features, and calculate physiological parameters with the end goal of making POCUS technology more accessible for emergency use and for broader use across the developing world.
With all the ultrasound AI news (here’s one from Monday) and the buzz around newer AI-enabled handheld ultrasound players, it can be hard to differentiate between what’s hot and what’s significant. The combination scale of Partners’ clinical and AI capabilities with Fujifilm SonoSite’s massive POCUS presence makes this alliance significant.
CMS Proposes Real Transparency
CMS took its biggest shot at achieving real healthcare cost transparency this week with a proposal that would force hospitals to disclose payor-specific negotiated rates. The rule focuses on 300 “shoppable services” that patients can schedule in advance, such medical imaging scans, lab tests, or childbirth.
- Foreshadowing – Hospitals started posting their gross rates in January, which did little to help patients understand actual costs, but may have served as a first step towards real transparency. Turns out that CMS’ Seema Verma’s 2018 warning that they were “just beginning” with transparency may have been much more than a soundbite.
- Proposal – If approved, in January 2020 all 6,000-plus hospitals that accept Medicare will have to post their negotiated rates for each payor online, while adhering to certain online readability standards. Hospitals that don’t adhere would face a $300 daily fine, which many find to be way too low.
- Fallout – To the surprise of no one, both hospitals and payors quickly opposed the proposal, suggesting that it’s bad for patients and somehow would reduce competition (debatable), while others argued that it exceeds the executive branch’s authority (more valid). Meanwhile, proponents highlight how it would move the healthcare into an open market system and suggest that opponents to this rule are really “the proponents of the status quo.”
The Wire
- Research from a MD Anderson team revealed wide variations in breast MRI technical quality across the U.S. following a review of 100 cases by three fellowship-trained breast radiologists and one breast imaging fellow. Of the 88 cases referred from facilities in the United States, 60 (68%) had at least one technical deficiency and 10 (11%) had more than five different technical deficiencies, with the most frequent deficiencies related to artifacts (74%).
- South Korean flat-panel DR developer, Rayence, signed a global deal to provide GE Healthcare with detectors for its X-ray systems. The companies have a history together, as GE acquired mammography assets from Rayence in 2013 and they signed a similar CMOS detector supply deal in 2017.
- A French research team led by Median Technologies found that using hybrid workflows in imaging-related clinical oncology trials reduced nonconformities (5% of all reports vs. 55%) and cut radiologist reading times (1.5 minutes vs. 11.5 min). The study’s hybrid workflow had radiologists perform baseline evaluations, with technologists performing subsequent evaluations (measuring targets, searching for new lesions) with the assistance of electronic-form reporting software (eCRF), that were later reviewed by radiologists. However, the hybrid workflow did add just over 12 minutes of technologist labor.
- In addition to sweeping transparency changes (see above), CMS’ proposed 2020 Medicare Physician Fee Schedule (MPFS) would bring a number of changes to imaging departments and providers. CMS is proposing a slight increase in the current conversion factor and reducing rates for a number of areas of imaging (radiology -1%, IR -2%, nuclear medicine +1%). CMS also revealed that although clinical decision support will still be required for advanced imaging in 2020, many will be relieved to learn that it will be an “educational year” (no penalties for non-compliance). Here’s the ACR’s analysis on what these changes mean to you.
- Dana-Farber researchers developed a deep learning tool that’s able to estimate real-world cancer treatment outcomes (e.g. disease progression and therapy response) as well as trained radiologists. The model was trained on 13,230 imaging reports (1,112 lung cancer patients) and then applied to a 109-image test set, identifying the presence of cancer and improvement/response or worsening/progression results with a >0.90 AUC. A later test using 15,000 different imaging reports was able to predict overall survival with the same accuracy as human reviewers. The researchers noted that the model could eventually annotate 2,000 patients’ imaging reports in 10 minutes, far less than the six months it would take a human curator to perform the same task.
- UC Berkeley was awarded a five-year $47 million grant from the National Institute on Aging to study how lifestyle changes affect the aging brain, using brain imaging scans (PET, tau PET, MRI) to assess the biological impact of these changes (shape, size, blood flow, etc.). The study will be incorporated into the Alzheimer’s Association’s U.S. POINTER clinical trial.
- ENDRA Life Sciences landed a $2.8 million private placement that it will use to fund ongoing studies, regulatory filings, and eventually the commercial launch of its TAEUS (Thermo-Acoustic Enhanced UltraSound) platform. ENDRA reports that the TAEUS platform will allow clinicians to visualize human tissue composition, function, and temperature in ways that rival CT or MRI, but at lower costs and at the point-of-care.
- An AHRA survey (n = 300 radiology professionals) explored the use of radiologist assistants (RAs) in the U.S., finding that 26% of organizations currently use RAs, with most organizations employing either one or two full time equivalent RAs (40% one, 23% two). RAs’ most common duties were fluoroscopic and invasive procedures (79% and 66%), while responses were mixed regarding the impact of CMS’ decision to allow billing for diagnostic imaging procedures performed by RAs under direct physician supervision (45% expect related increase in RA usage vs. 40% not sure, 40% believed that they would hire more RAs vs. 40% not sure).
- Hebrew University of Jerusalem researchers developed a quantitative MRI method that could detect molecular changes in the brain, potentially allowing clinicians to identify early signs of Alzheimer’s or Parkinson’s diseases. The team developed a tissue relaxivity approach that decodes molecular information from an MRI signal, giving insights into the molecular composition of lipid samples and region-specific molecular biomarkers that can currently only be done post-mortem.
- In his AHRA 2019 session, The Advisory Board’s Stuart Clark forecast that outpatient medical imaging volume will grow by 7% over the next 5 years, but hedged that this growth may be disrupted by reactions from payors and patients (increased deductibles, reduced reimbursements, shifts to lower-cost methods, lower demand). Clark forecast a hefty 16% increase in outpatient ultrasound use, followed by PET (+9%), radiography (+6%), CT (+4%), and MRI and mammography (both +3%), while nuclear medicine would fall 1%.
- A team of French and Quebec-based researchers found that shear wave elastography (SWE) can differentiate benign from malignant breast microcalcifications on ultrasound. The study looked at 29 patients with US-identified breast microcalcifications (13 malignant), assessing malignant calcification stiffness using SWE and then performing US-guided biopsy. The team found that SWE identified malignancy and detected invasive components with relatively high AUCs (0.89, 0.93), sensitivity (69%,75%), specificity (100%, 100%), negative predictive value (80%, 75%), positive predictive value (100%, 100%), and accuracy (86%, 85%). SWE’s breast cancer diagnosis advantages have been known for some time (including from this same team), but studies like this make Hologic’s move to acquire Supersonic Imagine sound pretty smart.
- Canon Medical Systems launched its ENCORE Orian MR upgrade program, which allows current Canon MR users (including Vantage and Atlas systems) to upgrade to the new Vantage Orian 1.5T “with significantly less downtime and a lower cost than purchasing a new system.” Canon/Toshiba has maintained the ENCORE upgrade program for years, covering previous MR generations and as well as its current ultrasound systems.
- A University of Pennsylvania team using iCAD’s PowerLook Tomo Detection 2.0 found that AI programs can help improve DBT accuracy and reduce radiologist reading times. The study compared the performance of a 24-radiologist group (w/ 13 breast subspecialists) reading 260 DBT examinations (w/ 65 cancer cases) with and without AI support, finding that AI improved malignant lesions detection (0.852 vs. 0.795 AUC), sensitivity (85% vs. 77%), and specificity (69.6% vs. 62.7%). The AI tool also shortened reading times (30.4 seconds vs. 64.1) and decreased recall rate for noncancers (30.9% vs. 38.0%).
The Resource Wire
– This is sponsored content.
- Four Qure.ai abstracts have been selected for RSNA19 covering: a new metric to evaluate radiology AI models, chest X-ray TB screening, segmenting and measuring ventricular and cranial vault volumes with AI, and how clinical context improves AI performance for cranial fracture detection.
- A study in JACR revealed that the rise of high-deductible health plans has led to greater patient concerns over imaging costs than ever before, while patient cost comparisons often leads to “confusion, misinformation, and opaqueness.” These are the exact patients who can be helped by the Medmo platform, which connects high-deductible patients with radiology centers, ensuring the best value for patients and a profitable revenue stream for imaging centers.
- In this blog post, Nuance Healthcare’s Diagnostic Division GM and VP, Karen Holzberger, shared some real-world examples of how PowerShare is helping providers #DitchTheDisk and improve patient experiences.
- The Focused Ultrasound Foundation’s Asia program is gaining momentum, highlighted by the upcoming 2020 formation of a Hong Kong subsidiary that will work with Asia-based philanthropists and distribute funds research institutions across Asia, in addition to the Foundation’s existing relationships and clinical trials on the continent.
- The POCUS Systems founding team has over 80 years of combined experience in the ultrasound industry.
- In this Carestream video, orthopaedic surgeon Dr. Bryan Den Hartog presents clinical images illustrating traditional CT vs. extremity CT imaging and discusses how the image resolution in the OnSight 3D Extremity System helps in his practice.
