“My overall, moral reaction is: Are you kidding me?”
NYU School of Medicine medical ethics director, Arthur Caplan, reacting to an Anthem practice that paid recent drug rehab patients directly rather than paying the provider. We’ll tie this into radiology below.
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Trump’s 2020 Budget Brings Big Healthcare Cuts
President Trump rolled out his 10-year 2020 budget plan, representing a step to make good on his “repeal and replace Obamacare” campaign promise while breaking his vow to leave “Medicaid, Social Security, and Medicare untouched.” Over the next 10 years, the budget proposal targets a $1.5 trillion cut to Medicaid (transferring $1.2t of it to states via block grants) and a $845 billion reduction in Medicare spending (with $269b of that reclassified to DHHS), theoretically achieving these savings by lowering prescription drug costs and targeting wasteful spending. Imaging will likely feel the impact of that last section, as one of the ways the plan will look to cut wasteful spending is to require prior authorization for high-cost medications and procedures (like imaging). This budget is far from official, but at this point it’s hard not to envision federal healthcare spending to be lower in this next budget.
Imaging Follow-ups Still Failing
New research published in AJR revealed that follow-up imaging recommendation rates can vary widely depending on provider site and more-notably confirmed that overall follow-up adherence remains very low. The 2-year study (n = 923,885 exams from U of Washington, 763,059 from Lahey HMC) revealed that follow-ups were far more likely to be recommended at Lahey (20.9% of all exams) than UW (11.4%), while only about half of the recommended non-mammography follow-ups at the two systems actually took place (51.9% at UW, 52.0% at LHMC). The study also revealed diverse modality-specific follow-up adherence rates, as UW saw the lowest rates with nuclear medicine (44.4%) and highest with MRI (63%) and LHMC had the lowest follow-ups with fluoroscopy (just 30.1%) and highest with ultrasound (63.2%). The researchers called for new technologies and processes to improve follow-ups, but didn’t discuss currently available follow-up solutions.
Imaging3, A Cannabis Company
The Imaging Wire finally has its first cannabis industry-related story, and although it doesn’t really involve the once-illegal drug, the deal’s crafty financial maneuvering may make you feel kind of funny. Imaging3 agreed to a reverse acquisition by an unnamed Los Angeles-based cannabis company, allowing Imaging3 to correct its financial issues (resolve debts, go private) so it can use more of its anticipated $3 million in new funding to develop and commercialize its long-awaited Dominion 3D X-ray imaging technology. Upon closing, Imaging3’s intellectual property, assets, and funding will be transferred to a new, privately-held company that will focus on medical imaging and operate separately from the cannabis company.
ACR Takes a Stand
ACR took a stand against recent “egregious” activities from Anthem and UnitedHealthcare, while touting its own role in protecting radiologists from reimbursement threats, and calling on members to share similar experiences with insurance payors.
- The Anthem case didn’t actually involve radiology, but it certainly was “egregious” and is still somewhat relevant given that Anthem is no stranger to imaging-related litigation. Sovereign Health is suing Anthem for directly paying patients rather than the now-closed substance abuse rehab system in an alleged effort to force Sovereign to join the Anthem network. This created major AR collection problems for Sovereign and highlighted one of the ethical problems in our healthcare system, since the recovering addicts sometimes used their Anthem checks in ways that didn’t include paying back Sovereign (some checks were as high as $130k and $375k).
- ACR also reemphasized its position against UnitedHealthcare’s imaging site-of-service preauthorization program, which officially launched on March 1st. The long-anticipated UnitedHealthcare program denies authorization for MR and CT services in hospital outpatient settings unless the patient qualifies for an exception, and forces providers to navigate the insurer’s prior authorization process for certain types of patients who would otherwise qualify (e.g. patients with contrast allergies or diseases that require frequent imaging).
It Pays to Save
Here’s a better way for insurers to pay patients. New research published in Health Affairs reveals that the niche practice of giving patients financial incentives to use lower cost providers may be an effective way to control costs and encourage healthcare consumerism. The study looked at 270,000 patients who participated in rewards programs in 2017, which gave patients between $25 to $500 for selecting lower-cost options, and reduced overall spending by 2.1% in the first year ($2.3 million). That included a 4.7% drop in MRI costs and a 2.5% reduction in ultrasound costs. Considering that a previous Yale study found that the average patient drives past SIX lower-priced providers on the way to an imaging procedure, due in large part to patients’ and physicians’ limited cost-consciousness, it’s safe to say there’s room to reduce overall imaging spending.
- New research from Brown’s Warren Alpert Medical School and Rhode Island Hospital (RIH) found that chest X-ray CNN accuracy fell by up to 5.2% when the algorithms were used on different patient populations than their training dataset, emphasizing the importance of locally-testing AI before adoption. The researchers trained the DenseNet and MobileNetV2 algorithms on NIH and RIH chest X-ray datasets, revealing 5.2% and 5% drops in accuracy when the RIH-trained CNNs were used to diagnose NIH images, while the NIH-trained CNNs’ accuracy fell by 3.6% and 3.7% when used to identify abnormal images from the RIH set.
- 24x7mag.com published another wide-ranging roundtable discussion, this time on the deceptively interesting spare parts sector and featuring leaders from Technical Prospects, Canon, GE, and PartsSource. The panelists were in agreement on a surprising range of topics, with all emphasizing the importance of choosing reliable suppliers that offer high levels of quality, assortment, efficiency, warranties, and tech support, and with less of a focus on the direct/OEM vs. 3rd party/reman debate than one may expect. The panelists forecast that the currently-saturated parts sector will see regulation-driven consolidation in the coming years while also predicting that healthcare providers will start storing more parts on-site and suggesting that new efficiencies will come from the expanded use of predictive analytics. The article is big, so check it out if you’re interested in going deeper.
- Fujifilm Medical Systems U.S.A. announced a partnership with Epsilon Imaging, allowing Fujifilm to offer Epsilon’s EchoInsight cardiac imaging visualization and analysis software embedded within Synapse Cardiology PACS. EchoInsight will enhance Synapse Cardiology PACS’ echocardiography diagnostics capabilities, specifically adding strain imaging and quantification.
- Signify Research made a guest appearance on Aunt Minnie Europe, forecasting that the expansion of AI will drive the adoption of quantitative MR imaging in clinical practice, automating “the time-consuming and often imprecise task of manually taking measurements of imaging features.” The firm listed a number of benefits that will come from quantitative imaging (improved accuracy, better intra-study comparisons, personalized treatment planning and response prediction) and suggested that quantitative imaging will gradually expand beyond neurology across all MRI subspecialties, as it overcomes a handful of technological and adoption barriers.
- New research in the Journal of Cancer Education reveals that physicians discuss lung cancer CT screening with only 18% of patients who currently smoke cigarettes and 10.5% of former smokers (n = 1,667, ages 55-80), likely contributing to lung cancer screening’s participation problem.
- Zebra Medical and the HealthNet Global division of India’s Apollo Hospitals Group (700 hospitals and 200 clinics) signed a $4.9 million partnership to bring AI imaging to India. The partners will collaborate on developing Zebra-made AI solutions, initially focused on a chest X-ray interpretation tool for TB, that will be deployed across India and customized for the Indian population. The hospitals will also be able to access Zebra’s existing algorithms such as solutions to spot brain bleeds and breast cancer.
- A pair of US senators introduced a bill to finally repeal the 2.3% medical device tax, which launched in 2013 to help fund Obamacare, but has been suspended since 2015 thanks to a pair of two-year moratoriums (2016-17, 2018-19). This repeal would be applauded across the medical device industry, as previous research suggests the tax dragged down manufacturer revenue (-$188M), gross margins (-$375M), and earnings (-$68M), and resulted in significant R&D funding cuts (-$34M).
- A study from a pair of Toronto General Hospital radiologists found that natural language processing (NLP) may be a valuable way to predict patients’ future radiology needs, potentially improving decision making, reducing costs, and expanding access to care. The study looked at 2,500 free-text radiology reports from patients being monitored for hepatocellular carcinoma (HCC), which typically requires consistent radiology resources that increase when cancer is detected. The study used two different two open-source NLP models and three ML algorithms, with the best-performing NLP/ML combination achieving 92% accuracy, 83% sensitivity, and 96% specificity.
- Curvebeam and Ibex Innovations announced a partnership to integrate IBEX’s Trueview scatter correction software into Curvebeam’s LineUp multi-extremity CT imaging system, increasing the system’s bone contrast by 37% and tissue contrast by 53%.
- A Mayo Clinic team found that ultrasound surface wave elastography (SWE) could be a viable option for spotting interstitial lung disease, offering sensitivity advantages versus pulmonary function tests and cost and radiation advantages over CT. The study (n=91 patients with lung disease, 30 healthy) found lung ultrasound SWE to be particularly good at distinguishing healthy patients from patients with mild lung disease (88% sensitivity, 97% specificity) and healthy patients from patients with any level of lung disease (92%, 89%), but struggled differentiating a group of health-to-moderate lung disease patients from patients with severe lung disease (50%, 81%).
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- Bellin Health Titletown Sports Medicine & Orthopedics of Green Bay, Wisconsin (located right next to Lambeau Field) became the latest orthopedic practice to install Carestream’s OnSight 3D Extremity System, specifically highlighting the cone beam CT’s image quality and performance during weight-bearing exams.
- This Focus Ultrasound Foundation blog post from ultrasound pioneer, Narendra Sanghvi, looks back on the modest beginnings and early development of focused ultrasound.
- POCUS Systems is approved as a Veteran Owned Business with the US Government Office of Veterans Business Development, paving the way for partnerships with the federal healthcare delivery systems.
- This Medmo video details how its healthcare marketplace platform and network of participating radiologists help underinsured patients pay as little as possible for their imaging procedures.