AHRA Takeaways | PET/SPECT Breakthrough | BCBS’ Big Experiment

“We will never solve the burnout problem in healthcare until we solve the business model problem in healthcare. Talking about, writing about, tweeting about burnout might make us feel better (momentarily), but we need to scale models that truly reward health, not volume. Not FFS.”

A tweet from physician and healthcare executive, Sachin H. Jain, MD.

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The Imaging Wire

Big AHRA Takeaways

AHRA 2019 was a blast. It was so good to learn more about this crucial part of radiology and it as great to meet more readers face-to-face. Here’s The Imaging Wire’s big takeaways from AHRA 2019:

  • All About Education and Certification – Don’t let the keynote’s opening dance routine to Poison’s ‘Nothin’ But A Good Time’ fool you. AHRA 2019 was serious about education and boosting the role of its CRA (Certified Radiology Administrator) designation. The AHRA team consistently encouraged its members to attain the designation and reiterated its goal to make CRA a job requirement for radiology department leadership positions.
  • Awesome, Awesome Attendees – This might be old news to AHRA vets, but the people of AHRA actually call this the “Family Reunion.” That says a lot and it’s supported by the fact that attendees were genuinely happy to be there with each other. The event was full of The Imaging Wire’s favorite type of people: humble and hardworking folks who’ve hustled their way up, take their profession seriously, and still have a lot of fun. If radiology conferences were “families,” AHRA would be RSNA’s hardworking but fun-loving cousin who would never schedule its “reunion” during a major holiday weekend.
  • This is No AI Show – AI may get the headlines, but it’s not super top of mind among most AHRA attendees. The imaging department leaders in attendance were far more focused on improving how they work with their teams, machines, and patients than pondering the changes that AI might bring (even when discussing tools that are totally based on AI). This may change over time, but it’s an important reminder for the folks making these headlines (both press and vendors) that the AHRA crowd is a lot more focused on how a solution helps their department than how it was made.
  • Marathon Sessions, Exhibit Sprints – I get it. This is an educational conference, so there’s going to be a lot of educational sessions. Based on attendance and engagement during these sessions, it’s easy to say AHRA succeeded in this aspect. However, making it to even a portion of the 150 exhibitors during the three-hour exhibit hall periods can’t be done. As one exhibitor shared, “the human part of me appreciates the short exhibit hall times, but the businessperson in me needs more time with our customers.” AHRA is one of the rare industry shows where customers actually outnumber sellers (and maybe this is why), but the “business person in me” definitely agrees that more exhibit hall time would help.

This was a solid show, AHRA team and attendees. See you next year.

PET/SPECT Breakthrough

A team of Japanese researchers developed a new imaging method that can simultaneously detect and image PET and SPECT radiotracers, reducing scanning times and patient radiation dosage. Here’s how:

  • The Tech – The team developed a new version of a Compton camera that uses silicon/cadmium telluride (Si/CdTe) to allow gamma ray detection in both low (for SPECT) and high (for PET) energy ranges.
  • The Test – Patients were given both 99mTc-DMSA (for SPECT) and 18F-FDG (for PET) radiotracers. Using the Compton camera and a new image reconstruction algorithm, the researchers simultaneously created two-dimensional images of each radiotracer in the patients’ organs.
  • The Next Steps – More trials are needed, but the researchers are optimistic that this new approach will lead to new types of imaging and help create new tracers.

BCBS’ Global Payment Experiment

A new NEJM article detailed encouraging results from Blue Cross Blue Shield (BCBS) of Massachusetts’ 8-year global payment experiment, finding that providers who enrolled in BCBS’ Alternative Quality Contract (AQC – incentivizes providers to stay within a care budget) had lower medical spending and equal-to-better quality of care compared providers using traditional plans (incentivizes performing services). Here’s how:

  • Shared Risk – The ACQ’s two-sided risk model refunded providers who stayed below their budgets with a portion of the savings, while providers who exceeded their budget had to cover a portion of their excess costs. Providers also received bonuses for achieving quality goals.
  • Actions – Initial savings relied on shifting services to lower-cost settings (e.g. shifting from hospital-based care to office-based care). However, longer-term reductions came from a drop in wasteful services (e.g. unnecessary lab/imaging tests and ED visits) and an increased focus on preventive care and chronic illness management.
  • Results – Average annual spending per-patient during ACQ’s 2009 to 2016 post-intervention period was 11.7% ($461/yr less) lower than per-patient spending in control states. Patient populations who were enrolled for longer periods achieved the greatest spending reductions (e.g. costs for enrollees active from 2010-2016 were 11.9% lower, while those enrolled from 2012-2016 were just 2.3% lower).

There will surely be a few who point out how ACQ undermines the hospital and physician business models that everyone is used to. However, there’s plenty of evidence to suggest that the healthcare business model deserves to be undermined (or perhaps overhauled) and until payors start rewarding for health outcomes over volumes, today’s healthcare issues (high costs, low profits, burnout, etc.) will persist.

The Wire

  • Signify Research shared insights on medical imaging machine learning regulatory approvals (106 approvals, 2014 to H1 2019), highlighted by a spike in approvals in 2018 (~58 approved) and revealing much greater ML progress in the U.S. and Europe (47 & 45 ML solutions approved in last 5.5yrs) than Japan and South Korea (just 5 combined ML solutions approved). Machine learning solutions for brain imaging had the highest share of regulatory approvals in both the U.S. (26%) and Europe (33%), while breast imaging solutions were a close second in the U.S. (21%) and lung imaging solutions were the second most-approved in Europe (20%).
  • VIDA Diagnostics landed a $1 million strategic investment from UnityPoint Health Ventures (the VC arm of the large Iowa health system) with the goal of developing and commercializing VIDA’s LungPrint AI-powered lung CT analysis solution (flags lung density abnormalities). VIDA will have access to UnityPoint Health’s multi-state hospital network and clinicians, who will contribute insights to support VIDA’s solution roadmap and commercialization processes.
  • Ikonopedia officially launched its Automated Combined Reporting Package which automatically combines results from a range of breast health tests (mammography, US, MRI, biopsy) into a single clinical report for the referring physician. The Combined Reporting Package is used in conjunction with Ikonopedia’s Closed-Loop Resolution Manager and are intended to improve communication, follow-up, and efficiency.
  • Israeli ultrasound startup, iNNOGING, has been busy, launching its new Ultrasound Simulator (a hardware + software platform to help users practice US applications), adding ultrasound leader Professor Larry Needleman to its board, and preparing to start clinical trials for its Ultrasound Analyzer solution (a remote/offline platform that allows physicians to manipulate captured ultrasound video and perform exams without the patient present).

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.
  • 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.
  • 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.

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