ACR Takes a Stand | COVID-19’s Volume Impact

“ . . . any boards certifying diagnostic radiologists, interventional radiologists, nuclear medicine physicians, radiation oncologists, and medical physicists should minimize power imbalance in decision-making between those professionals and the certifying body.”

The ACR’s official position statement on certifying boards, including one board in particular.

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The Imaging Wire

ACR Takes a Stand

After years of complaints against the ABR’s monopoly mainly coming from individual blogs, lawsuits, and social media posts, the American College of Radiology took a stand against the ABR on behalf of its constituents.

  • ACR’s Position – The ACR’s new ‘Resolution 50’ stated its official position that any certifying boards “should minimize power imbalance in decision-making,” shouldn’t require radiology professionals “to waive any of their fundamental due process rights,” and should work with the ACR Council Steering Committee before changing their policies. The ACR didn’t actually mention the ABR in its statement, but it’s clear what certifying board they were referring to.
  • Position Results – ABR critics appeared to appreciate the ACR’s official position, even if it could be seen as a “purely symbolic” gesture. The hope is this is the start of the ACR’s “increasingly strong position” against the ABR’s power imbalance. Given that the ACR’s members voted unanimously in favor of this position, it could be headed in that direction.
  • What’s the ABR’s Direction? – It may take quite a while for the ABR’s policies to get closer to what many radiologists view as fair. However, the certification body has already been retreating in recent weeks after facing backlash for a change to its user agreement that required physicians to waive their right to sue the ABR (among other things). It also appears that the belief that the ABR doesn’t operate with radiologists’ best interest in mind is becoming a consensus opinion (or to some a factual statement), and having unhappy and distrusting customers is never a lasting business model.

COVID-19’s Volume Impact

There’s been plenty of case-by-case coverage of how the COVID-19 pandemic dragged down imaging volumes and plenty of Imaging Wire readers are experiencing it first-hand. However, a new Harvey L. Neiman Health Policy Institute study brought us perhaps the most scientific account of CV19’s imaging volume impact so far.

  • The Study – The retrospective study reviewed imaging case volumes in a large NY state healthcare system from January 1 to April 18 in both 2019 and 2020 (23 hospitals, 52 urgent care centers, 17 imaging centers), revealing a 28% overall imaging volume decline during COVID-19 pandemic’s first 7 weeks. For context, the healthcare system’s imaging volume increased by 0.88% during the first 9 weeks of 2020 (pre-COVID was awesome).
  • The Details – Imaging volumes experienced a steep decline over the first four weeks of the COVID-19 study period, although the greatest decline took place during the seventh week (40%). These declines varied by hospital setting, with outpatient volumes falling by a whopping 88% and emergency imaging declining by 46%, while inpatient imaging fell by just 4%. Declines also varied by modality with mammography falling by 94%, followed by nuclear medicine (85%), MRI (74%), ultrasound (64%), interventional radiology (56%), CT (46%), and X-ray (22%).
  • Takeaways – It may seem like good news that overall imaging volumes only fell by 28% during this study period, noting that many in the industry forecast 50% to 70% declines. However, the fact that imaging volumes experienced the greatest declines during the final week of the study suggests that overall declines might have been much greater than 28% if the study period extended into May. Additionally, the financial impact of the steep imaging declines in key departments (outpatient imaging) and modalities (mammography, nuclear medicine, MRI) can’t be understated.

The Wire

  • Tele‐Echocardiography: Norwegian researchers found that echocardiography performed by on-site nurses and interpreted by an out‐of‐hospital cardiologist is “feasible and reliable,” potentially addressing disparities in regions with few cardiologists. The researchers had nurses perform echocardiography on 50 consecutive patients at an outpatient heart failure clinic, transferring the echocardiograms to an out‐of‐hospital cardiologist, finding that 94% of the assessments were feasible.
  • Nucleus.io Going to Europe: NucleusHealth’s Nucleus.io medical image management platform gained CE Mark approval last week, expanding the platform beyond the U.S. where it achieved FDA clearance in 2017. The Nucleus.io PACS platform is offered to European providers in a platform-as-a-service (PaaS) structure, while the Nucleus.io software-as-a-service (SaaS) solutions (workstation, image exchange, storage) will expand to Europe in early 2021.d
  • CTA Dominant for PE: A new study in Circulation: Cardiovascular Imaging found that CT pulmonary angiography (CTA) is the dominant modality for pulmonary embolism (PE) diagnosis (78.2%), followed by ventilation/perfusion scanning (12.9%), DVT imaging (3.3%), and pulmonary angiography (1.6%). The study reviewed imaging data from 38,025 multinational patients diagnosed with PE between 2001 and 2019, finding that CTA use for PE diagnosis increased significantly from 46.5% in 2002 to 91.7% in 2018.
  • DOJ Investigating Omega Imaging: The U.S. Department of Justice joined in on a whistleblower’s False Claims Act suit accusing Omega Imaging Inc. of providing contrast enhanced imaging without proper physician supervision and billing Medicare for these services. The Southern California imaging group (11 facilities) is also accused of providing imaging services at facilities that lacked proper accreditation, while the DOJ declined to investigate a third kickback scheme allegation against Omega Imaging.
  • Urgent Deferrals: General practitioners in the UK are demanding a full investigation into the “hundreds” of imaging referrals that were rejected by local NHS trusts up to three months after they were first submitted, including “urgent” referrals to diagnose suspected cancer. The trust is operating with higher urgency standards during the COVID-19 emergency, although urgent cases (suspected cancer, trauma, infection) should still be prioritized.
  • Meniere Breakthrough: Swedish researchers achieved a milestone in the understanding of Meniere’s Disease (a common cause of vertigo, hearing impairment, and tinnitus) using a technique that leverages Micro-CT and synchrotron imaging. The researchers used the technologies to image a part of the inner ear enclosed in the body’s hardest bone, discovering an inner ear drainage system that could explain how fluid is absorbed and improve understanding of how and why Ménière’s disease arises.
  • Fujifilm’s CV19 AI: Fujifilm began development of a new AI tech that would use COVID-19 patients’ chest CT scans to quantify CV19 pneumonia and help guide their treatment. The new algorithm will be jointly developed with Kyoto University (a historical Fujifilm AI partner) and trialed in medical institutions across Japan.
  • Ultrasound Sleep Apnea Detection: New research out of Taiwan found that tongue stiffness measured with ultrasound shear wave elastography (US SWE) can be used to identify people with obstructive sleep apnea (OSA). The study performed transcutaneous submental SWE on 46 people (26 w/ OSA), finding that tongue stiffness was significantly higher in awake patients with OSA than the controls, detecting OSA with AUCs of 0.82 and 0.88.
  • ARTMS’ $19m: Imaging radioisotope developer ARTMS closed a $19m Series A round (following $3m venture round in 2017) that it will use to expand the commercialization of its QUANTM Irradiation System (QISTM) and sign new partners for the development of cyclotron produced 68Ga-based diagnostic agents. QISTM allows the decentralized and local production of several key medical isotopes (68Ga, 89Zr, 99mTc, 64Cu).
  • NPs & PAs Profitable, but Uncommon: Medscape’s new 2020 Radiologist Compensation Report revealed that radiology NPs and PAs are still relatively uncommon even though they are profitable. The report found that 63% of radiologists don’t use NPs or PAs in their practice (28% use PAs, 22% NPs), although 52% of those who do revealed that NPs/PAs improve profitability and only 6% said they hurt profitability.
  • Volpara & Ambry’s Precision Partnership: Volpara Solutions signed a collaboration agreement with genetic testing company Ambry Genetics to incorporate Ambry’s CARE (Comprehensive, Assessment, Risk, and Education) genetic risk assessment program with Volpara’s cancer screening platform. The companies will add an online ordering process for Ambry’s genetic testing within Volpara’s Aspen Breast practice management software and will leverage Volpara Density’s breast cancer risk assessments, which is often required to confirm reimbursement for supplemental screening and genetic testing.
  • Telerad Blueprint: With home teleradiology emerging as a key outcome from the COVID-19 emergency, a new AJR article detailed the big takeaways of the University of Alabama at Birmingham radiology department’s rapid deployment of 25 PACS workstations to radiologist homes (previously had 2 remote stations). Here they are: 1) Due to budget and availability issues, they prioritized which radiologists would receive a remote PACS workstation (priority on emergency rads, specialty and multi-specialty/modality rads, and those who are at-risk, while excluding breast rads due to decline in mammograms); 2) To ensure functionality they adopted hardware-based VPNs, required that all radiologists have >100 Mbps internet connections, and installed remote maintenance software; 3.)To ensure perceived fairness, rads who received workstations were asked to work more shifts or still come into the hospital for some shifts; 4) Even with remote rads, the hospital kept at least one radiologist on-site for each section.
  • Incentives, Gender, and Radiologist Pay: Medscape’s new 2020 Radiologist Compensation Report detailed the role of radiologists’ annual incentive in their $427k average annual compensation (5th highest), as the average performance bonus was $77k (4th highest). The report also highlighted a continued gender disparity in radiology ($438k men vs. $386k women) even though women spend more hours per week with patients (34.5 vs. 32.5hrs).

The Resource Wire

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