A Medicare AI Milestone

“Gross, I know, but medicine is full of perverse incentives.”

Dr. Luke Oakden-Rayner explaining why Medicare reimbursements might get more hospitals to adopt imaging AI, since saving time and lives hasn’t always been enough justification for many.

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The Imaging Wire

Viz.ai’s Medicare Milestone

Viz.ai’s ‘Viz LVO’ stroke platform just became the first AI software granted a Medicare New Technology Add-on Payment (NTAP), representing a major milestone for the company and for the business of imaging AI.

  • The CMS Ruling – With the ruling, providers who use Viz LVO to triage suspected stroke patients can receive Medicare payments of up to $1,040 per use.
  • About NTAP – CMS created NTAP to encourage the adoption of cutting-edge technologies that demonstrate “substantial clinical improvements,” which in Viz LVO’s case are reduced time to treatment and improved clinical outcomes.
  • But $1,040 per Patient? – A thousand bucks might seem high, but that’s CMS’ “up to” reimbursement rate. These reimbursements are intended to cover the cost of a provider’s annual Viz LVO subscription, so the more a provider is reimbursed for Viz LVO the less they receive per use. Either way, the reimbursements should help most providers break-even on their Viz LVO subscriptions while improving stroke care.
  • Significance – When Viz.ai called this “a groundbreaking ruling,” that wasn’t just press release hyperbole. Until now, most imaging AI companies had to rely on efficiency and clinical benefits as the core of their value position, while the lack of adequate reimbursements remained a major AI adoption barrier. With NTAP eligibility, imaging AI can now be a revenue generator for providers, at least if they use Viz LVO, Heartflow’s FFR-CT, and mammography CAD.
  • Industry Reactions – It’s safe to say that this ruling caught the industry’s attention. A tweet from AI star Curt Langlotz (w/ a lengthy comment thread) exclaimed that he “did not think this would ever happen.” Viz.ai’s NTAP was even big enough to get us another awesome blog post from Dr. Luke Oakden-Rayner, who reminded everyone that reimbursements are “how medicine incentivizes actually helping people.” And that’s the kicker here. If AI reimbursements become more common, imaging AI might start getting the attention of hospital executives and could give more AI companies a path towards commercial viability (beyond VC funding).

The Wire

  • KA’s 510(k): KA Imaging announced the FDA 510(k) clearance of its Reveal portable dual-energy X-ray detector, allowing dual-energy imaging at patient bedsides for the first time and giving KA Imaging a much greater commercial role in the imaging market. The unique Reveal detector leads with a low-cost value prop (less than 1/4th of other dual energy detectors) and its ability to capture bone and tissue images in a single X-ray exposure (e.g. for lung scans without obstruction).
  • A Case for Clinical Info: A new study review out of Australia (n = 20 previous studies) provided more evidence that clinical information improves radiology reports, while encouraging the creation of clinical information standards for imaging referrers. Of the reviewed studies, 14 out of 16 found that clinical info improves radiology report accuracy (2 had no improvement), 3 of 3 found that it improves reporting confidence, 3 of 3 found that it improves the clinical relevance of reports, and 1 of 2 found improvements in reporting time (-6% & “slight increase”).
  • Sonosite’s COVID 510(k): Fujifilm Sonosite announced that its entire POCUS portfolio is now approved by the FDA for performing lung and cardiac imaging in COVID-19 patients. With Sonosite now allowed to market its POCUS lineup for COVID-19 care, the company released a user guide on how to recognize the most typical COVID-19 findings in POCUS images.
  • CXR Lung Cancer Predictor: A Mass General Hospital team developed an AI model that can predict long-term lung cancer risk based on a patient’s chest X-ray, potentially identifying patients who would benefit from ongoing CT screening. The team developed their new CXR-LC model using EMR data from 41,856 patients (CXR, age, sex, smoking status), finding that CXR-LC was more sensitive than the CMS’ scoring system (74.9% vs. 63.8%) and missed 30.7% fewer lung cancers.
  • Radiology Pay Gains: AMGA Consulting’s 2020 Compensation and Productivity Survey (n = 127k providers) found that median radiologist pay jumped by 5.3% in 2019 to $509k, outpacing a 4% increase in productivity to 10,200 wRVUs. Radiology’s pay and productivity growth beat the survey’s overall pool of physicians, which saw compensation increased by 3.79% and production increase by 0.56%.
  • Faster Port Placements: After UT Southwestern’s wait times for port placements in Interventional Radiology increased from 14 to 27 days, the hospital instituted a number of changes that reduced average wait times by 22% (beating their goal of a 15% reduction). To address its workflow bottlenecks, the hospital added two reserved slots in the attending physician’s morning clinic schedule and added three guaranteed daily spots for port placement in the angiography suit, leading to improvements in port requests (+17%), completed clinic visits (+19%), port placements (+19%), and most notably wait times between request and clinic visit (-49%).
  • Choosing Wisely Isn’t Enough: New research in JAMA Network Open found that the release of Choosing Wisely recommendations wasn’t enough to bring meaningful changes to low-value carotid imaging in the VA system, suggesting that new efforts targeting ordering physicians are necessary. The study of 809,071 VA carotid imaging exams from 2007 to 2016 found a modest decrease in imaging rates for carotid bruits before Choosing Wisely launched in 2013 (but not after), while appropriate utilization rates for preoperative carotid imaging and syncope imaging did not significantly change throughout the period.
  • Another Walmart Clinic: Walmart continued its Walmart Health clinic expansion last week, opening its 6th retail health center, and revealing plans to open more. The new Newnan, Georgia clinic joins existing/forthcoming clinics in Georgia (4 in GA), Arkansas, Florida, and Illinois that offer a range of medical services (yes, including imaging).
  • LCS CT False Positives: A new study out of Brigham and Women’s Hospital revealed that lung cancer screening CTs can have a 13% false positive rate (n = 3,735 patients, 5,835 CTs), compared to true positive results in just 2% of cases. The researchers found that patient age (OR 2.08), baseline scan (OR 1.43), the presence of COPD (OR 1.34) and emphysema (OR 1.32), and radiologist experience (OR 0.59) are the greatest predictors of false positives. They also suggested that the greatest improvements can be achieved by focusing quality assurance efforts on radiologist performance and site-specific operations.
  • The Pandemic’s Imaging Drag: A new report from Omnia on Auntminnie.com forecasts that the global medical imaging hardware market will decline by 4.6% in 2020 (from $26.92b in 2019), as COVID-related increases for mobile X-ray (+80%) and CT (+5%) aren’t enough to overcome related drops in the ultrasound (-8%), MRI (-18%), and the total X-ray (-4%) segments. On a brighter note, Omnia expects imaging hardware demand to rebound going forward (+2% in 2021, 5% in 2022) and forecasts that healthcare AI revenues will maintain a massive 54% CAGR through 2023.
  • A Case for Dual-Phase Brain FDG PET/CT: Dual-phase FDG PET/CT can help doctors detect and diagnose malignant brain tumors by eliminating background activity that has historically limited the value of brain FDG PET/CT. That’s from a U of Minnesota study that had two independent observers evaluate 51 malignant tumors in 32 patients (37 viable and 14 nonviable lesions) using scans performed 30 minutes and 3 hours after FDG administration. The researchers found that diagnostic accuracy improved with the delayed (3hr) exams, although sensitivity, specificity, and accuracy were similarly high for both the early and delayed dual-phase FDG PET/CT scans.
  • No Warning Needed: The International Contrast Ultrasound Society (ICUS) petitioned the FDA to remove ultrasound contrast agents’ “black box” warnings. The group cited clinical studies suggesting that ultrasound agents pose no known health risks and can save lives. ICUS also suggested that the “outdated” labeling requirement may be deterring patients who could benefit from contrast-enhanced ultrasound exams.
  • SR for MS MRI: Cleveland Clinic researchers found that interpretation times for follow-up multiple sclerosis (MS) imaging significantly decrease with structural reporting (SR). The Academic Radiology-published study found that the initiation of SR for MS MRI significantly reduced mean (11 to 8.5 minutes) and median (8 to 6 minutes) interpretation times.
  • Pediatric Appendicitis Ultrasound Gains: A shift from CT to ultrasound for pediatric appendicitis is adding value to the health care system without adversely affecting negative appendectomy rates. That’s from a retrospective JACR study of 104,033 children who underwent an appendectomy between 2004 to 2018, showing that CT utilization decreased from 56.8% to 18.6% of cases and ultrasound utilization increased from 26.4% to 63.4%, while negative appendectomy rates decreased from 3.74% to 3.14%.

The Resource Wire

– This is sponsored content.

  • Patients have become savvy healthcare shoppers who increasingly rely on price information to make decisions about their care. Join Healthcare Administrative Partners’ CRO, Rebecca Farrington, as she discusses price transparency & consumerism in radiology in this upcoming RBMA webinar.
  • The introduction of ultrasound into musculoskeletal care has been a game-changer, revolutionizing the level of precision MSK physicians can bring to patient care. This GE Healthcare profile details how one physician used point of care ultrasound to help improve performance and effectiveness.
  • Bayer’s new Gadavist Imaging Bulk Package multi-patient dosing system eliminates the waste associated with individual GBCA vials, benefiting rad techs (improved workflow, increased patient focus), administrators (reduced costs / waste, increased productivity), and patients (greater dosage consistency).
  • This Hitachi post details how human centered design led to the Scenaria View CT’s innovative Lateral Shift Table, which increases spatial resolution, allows accurate centering, and reduces dosage.

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