A Really Strong Signal

“That’s a really strong signal,”

Oregon Health & Science University’s Stephan Lindner PhD after discovering that an alternative Medicaid payment model cut imaging by over 42%.

Imaging Wire Sponsors

  • Focused Ultrasound Foundation – Accelerating the development and adoption of focused ultrasound.
  • GE Healthcare – Providing point of care ultrasound systems, from pocket-sized to portable consoles, designed to support your clinical needs and grow along with your practice.
  • Healthcare Administrative Partners – Empowering radiology groups through expert revenue cycle management, clinical analytics, practice support, and specialized coding.
  • Hitachi Healthcare Americas – Delivering best in class medical imaging technologies and value-based reporting.
  • Nuance – AI and cloud-powered technology solutions to help radiologists stay focused, move quickly, and work smarter.
  • Riverain Technologies – Offering artificial intelligence tools dedicated to the early, efficient detection of lung disease.

The Imaging Wire

Walgreens Clinics

Walgreens announced a big step in its healthcare expansion strategy, signing a $1b deal with primary care company VillageMD that will bring health clinics to 500-700 of its drugstores over the next five years.

  • The Alliance – Walgreen’s $1b investment will give it a ~30% stake in VillageMD, which will staff and operate the Walgreens clinics, and pay Walgreens rent for each location.
  • The Clinics – The new Village Medical at Walgreens clinics will offer a range of services, including checkups, walk-in urgent care appointments, and testing / diagnostics, while adding greater pharmacy coordination than most clinics can offer. Most of the 3,300-sq foot clinics (w/ ~ 9 exam rooms) will open in regions with limited healthcare access.
  • Spotting the Trend – Walgreens is among a number of major pharmacy and big box chains doubling down on healthcare, which seems like a smart move given the opportunities in healthcare and the challenges facing traditional brick & mortar retail. Walgreens already operated primary care centers at 14 of its pharmacies, but the VillageMD alliance significantly expands its role in healthcare. It also represents another milestone in healthcare’s consumerization trend, coming as Walmart expands its own health clinic footprint and as Amazon builds its health portfolio.
  • Imaging Impact – It appears that many of the Walgreen Clinics will have on-site X-ray and ultrasound systems. However, if Walgreen’s primary care expansion proves to be part of a more substantial shift in where/how health services are delivered, it could have a much greater imaging impact.

Value-Based Alternative

An Oregon Health & Science University study revealed that the state’s alternative Medicaid payment model led to a 42% reduction in imaging services at participating clinics.

  • The Model – Launched in 2013 to discourage low-value care, the alternative model reimburses providers with a fixed monthly fee per patient rather than per-visit.
  • The Study – The researchers reviewed 150k Oregonian’s Medicaid claims between 2010 and 2017, comparing healthcare services performed at health centers using the alternative model against centers using the traditional per-visit model.
  • The Results – As many likely anticipated, the clinics participating in the alternative model ordered 42.4% less imaging services than health centers using the traditional model, while driving more non-billable services (e.g. telephone consultations).
  • The Takeaway – The immediate and downstream impact of low-volume imaging is well known at this point (here are some other examples) and this Oregon pilot could serve as a model for states across the country to address this issue.

The Wire

  • AI Avoidance: U.S. med students expect that AI will play a significant role in medicine, particularly in radiology, and this expectation makes about half of them “less enthusiastic” about pursuing a career in the specialty. That’s from a 2017/2018 survey of 156 med students, 66% of whom agreed that AI would have the greatest impact on diagnostic radiology and 44% of whom are less enthusiastic about radiology because of the AI threat. The study called for more formal AI education in med schools to ensure that radiology continues to attract top talent and to help prepare future physicians for an AI-integrated future.
  • Zebra’s Canada Alliance: Zebra Medical Vision announced an alliance with VC firm TELUS Ventures that will give the Israeli AI company more funding ($50m as of 2019) and support its expansion across Canada. Although the announcement largely focused on Zebra’s Canadian expansion, it will also use the new funding to expand into new modalities and care settings.
  • Evidence-Based CXR Reductions: A New York City area hospital was able reduce its monthly portable chest X-ray utilization in the ICU by 37% (733 to 463) without negative healthcare consequences (no increases in unplanned extubations or ventilator days) by adopting evidence-based guidelines. Over a 6-month period, the hospital introduced new protocols and workflows to limit chest X-rays to specific situations (e.g. on admission, after central line placement), leading to the 37% utilization cut and eliminating over $4,200 in monthly CXR-related costs (labor, capacity, etc.).
  • Our Uneven Recovery: New analysis from Jefferies and covered by Medtechdive.com revealed that the hospital volume rebound is stalling as COVID-19 surges in new areas. Using cellular tower data from 3,300 U.S. healthcare facilities, Jefferies reveals that hospital traffic grew by just 0.1% during the week of June 28 after peaking in the first week of June (+7.3%). Jefferies noted traffic declines in several key states (AZ, Texas, NY) and forecast similar declines in Florida. This isn’t a big surprise given the mounting emergencies across many southern and western U.S. states, but it also suggests that the rebound in hospital traffic (or patient comfort) won’t be linear.
  • Butterfly in the News: Butterfly Network scored another big PR win last week, as a CNN Business article highlighting how Butterfly’s handheld ultrasound system is helping in the COVID-19 fight was picked up by dozens local news sites across the country. The article focused on the Butterfly iQ’s portability, low costs, smartphone-based operation, and big-name funders, while briefly mentioning handheld systems from other major OEMs.
  • Complication Registry: A new study in the European Journal of Radiology from a team of Dutch radiologists detailed the results of their radiology complications registration system, suggesting that implementing a system like this is feasible for other practices. During its first five years, 77 cases were logged in the complication registry including 34 diagnostic complications (21 perceptual, 13 cognitive), 19 interventional radiology complications (9 due to hemorrhage), and 14 organizational complications (5 due to wrong body part/side/site). Although most complications resulted in no or mild harm (n = 35, 10), the registry logged a number of severe or fatal outcomes (n = 6, 5; mainly from interventional procedures).
  • Therapixel Cleared: French breast imaging AI company, Therapixel, announced the FDA approval of its MammoScreen reading aid for screening mammography. MammoScreen detects and characterizes suspicious soft tissue lesions and calcifications in mammogram images, scoring each lesion based on malignancy likelihood.
  • USPSTF Expands LD-CT: The U.S. Preventive Services Task Force (USPSTF) recommended expanding the eligible age range (50-80yrs vs. 55-80yrs) and broadening the risk threshold (20 pack-year history vs. 30 pack-years) for annual low-dose CT lung cancer screening. The update from the Task Force’s 2014 guideline is motivated by new evidence on the benefits of lung cancer screening and is open for public comment through August.
  • Quantib’s AI Integrator FDA-Approved: Dutch AI firm, Quantib, announced the FDA approval of its AI workflow integration platform which, as its name suggests, is intended to integrate Quantib’s current and future algorithms into radiology workflows. The Quantib AI workflow integration platform is the company’s fifth FDA-approved solution and apparently comes with an increased focus on the U.S. market, as the announcement also revealed plans to open Quantib’s first U.S. office.
  • Another GBCA Debate: The debate over the safety of gadolinium flared up again last week after a JACR paper advised the use of gadoteridol (aka Bracco’s Prohance) to limit the risk of being sued for gadolinium deposition disease (GDD). Within days, a JACR letter to the editor criticized the paper for promoting gadoteridol, suggesting that the recommendation contradicts guidance from the FDA and ACR and is mainly based on research backed by Bracco. The authors of the original paper quickly responded, clarifying that they advised the use of gadoteridol to limit legal risks, not patients’ health risks.
  • Infervision in the USA: Infervision announced the FDA approval of its InferRead Lung CT.AI solution (already CE-approved), which uses AI to perform lung segmentation and identify / label lung nodules. Although this is Infervision’s first FDA-cleared product, InferRead Lung CT.AI has been clinically available for five years and is already in use at 380 hospitals globally.
  • Hitachi & Hoya Renew: Hitachi and Hoya (Pentax’s parent company) extended their endoscopy ultrasound system alliance for another five years, ensuring that Hitachi will continue to supply Hoya/Pentax with ultrasound systems and parts, even after Hitachi Imaging’s planned integration with Fujifilm. Hitachi has operated endoscopy ultrasound partnerships with both Hoya/Pentax and Olympus for years.

The Resource Wire

– This is sponsored content.

  • Severe sepsis strikes more than a million Americans every year at an annual cost of more than $20 billion. Learn how point of care ultrasound can help improve sepsis outcomes in this GE Healthcare paper.
  • Hitachi Healthcare Americas’ latest blog provides some insights into what “normal” imaging operations will look like as we emerge from the COVID-19 pandemic.
  • In its latest Q&A, Nuance sat down with Imbio founder Mike Hostetler to discuss how Imbio’s lung AI models support lung disease diagnosis and to share about Imbio’s AI Marketplace partnership with Nuance.
  • Learn about the different PPP loan forgiveness forms, limits on payroll forgiveness, and next steps in this article from Healthcare Administrative Partners.

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