Empathy Test | Perspectives on Transparency | Mammography Slowdown

“I have no idea what any of this ‘transparency’ will actually accomplish. My hope is that it will help to enlighten the fact that private pay and high deductible patients are getting the shaft, and that needs to change.”

An unnamed healthcare provider chief of staff on the potential impact of the upcoming changes to healthcare cost transparency.

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The Imaging Wire

Med School Empathy Test

There’s a lot of talk about empathy in healthcare, but a new study in The Journal of the American Osteopathic Association went a step further. The study established an empathy level baseline among medical students and suggested that med schools “could” use empathy tests (in addition to grades and MCAT scores) when evaluating applicants. Here are some details:

  • The Study – A Thomas Jefferson University team had 16,760 osteopathic medicine students fill out an empathy questionnaire with the goal of establishing empathy norms for med school students.
  • Opponents Say – Empathy can be taught, is already well covered in med school, is now addressed in the MCAS, and isn’t as important for certain specialties (e.g. radiology and surgery).

Although we’re unlikely to see empathy scores rival the importance of the MCAS in the near future, conversations about the importance of soft skills like creativity and empathy in medicine are growing more common, partially in reaction to many medical schools’ focus on memorization.

Perspectives on Transparency

As the White House and CMS’ aggressive push towards healthcare cost transparency gains momentum, a Reaction Data healthcare leader survey (n=286) revealed overall positive perspectives on the executive order, but neutral expectations for its effectiveness, and variations in how it will impact their organization.

  • On a scale of 1 (a “horrible idea”) to 6 (a “great idea”), 69% of providers viewed the transparency push positively (23% with a 6 score, 7% with a 1 score) and 80% of payers viewed it positively (40% with a 6 score, 0% with a 1 or 2 score).
  • However, few of the surveyed leaders were confident that the change would be implemented effectively, with 62% of providers giving it a 1-3 score (19% with a 1 score, 11% with a 6 score) and all payers scoring it between 3 and 5 (50% with a 4 score).
  • Unsurprisingly, both providers (63% with 3 or 4 score) and payers (50% 4 score) were largely neutral on how this executive order will impact their organization.

Mammography Slowdown

Signify Research forecast a slowdown in the mammography systems market due to the overall maturation of the DBT segment. However, there are some subplots to this DBT-focused story:

  • U.S. Saturated – The firm specifically highlighted saturation in the U.S. DBT installed base, which now has at least one DBT unit in use at 61% of breast imaging facilities, and experienced falling DBT growth rates since a 2017 peak (annual growth down from 11.5% in 2015 to 8.5% in 2018). The U.S. market arguably has more influence on breast imaging than any other modality or imaging segment (U.S. is 55% of the global mammography market), so slowing in the U.S. has major global market implications.
  • Pricing Pressured – Just in time for slowing demand, new competitors are entering the DBT market (e.g. Fujifilm) and placing greater pressure on mammography system ASPs. Meanwhile, DBT market saturation will shift more focus to $40k-$50k software upgrades (vs. $300k hardware upgrades), significantly reducing revenue per deal.
  • Alternative Modalities – Although mammography continues to dominate, interest in alternative modalities (e.g. breast ultrasound and breast MRI) is increasing as breast imaging transitions to a multi-modality practice.
  • Vendors React – Life has been good for the breast imaging leaders, but the slowing DBT market is prompting them to seek growth in other segments (e.g. Hologic expanding its portfolio across breast health) and push their new modalities (e.g. GE and Siemens emphasizing ABUS).

The Wire

  • With gaming education techniques increasingly being used in radiology residency programs, a team from the University of Maryland School of Medicine published guidelines for a gamified training curriculum. The report suggested that gaming training programs should: 1. Provide suggestions and feedback on progress; 2. Include achievable goals focused on patient care and outcomes; 3. Feature milestones to show progress and build students’ pride/confidence; 4. Position failure as a learning event; and 5. Expose students to a wide range of interactions, techniques, and strategies.
  • A study from a UCSF-led team (n=150 patients) added new evidence that Gallium-68-labeled PSMA-11 with PET/CT or PET/MRI is effective for biochemically recurrent prostate cancer management, achieving a 91.5% positive predictive value (up to 100% per region), 89.9% sensitivity (up to 100% per region), and “substantial to almost perfect interrater reliability.”
  • Research from a Harvard-led team explored reasons for cascading care after incidental findings. The survey proposed two patient vignettes (5mm pulmonary nodule in chest CT, and abnormal hemoglobin and hematocrit in blood work) to 376 general physicians, finding that 57.6% would follow a specialist’s recommendation rather than follow guidelines and 62.4% would do further testing in the absence of guiding evidence. A leading 58.6% of these respondents pursued incidentals because it “seemed clinically important,” followed by adherence to practice/community norms, lawsuit concerns (especially if they were involved in a previous lawsuit), and due to the advice of another doctor and/or request from the patient.
  • A new post from Signify Research detailed the growing radiology business intelligence solutions market, forecasting that the segment will maintain a hefty 18.7% CAGR through 2023 when it reaches $293.5 million. At least on the supply side of Imaging IT, Signify believes that this growth will be driven by Imaging IT vendors’ desire to: 1. Have a complete portfolio and defend against competitors; 2. Guide workflow optimization; 3. Expand to other budgets outside of radiology; 4. Create opportunities to grow professional services revenue; and 5. Make vendors’ total imaging IT solution more “sticky” by improving their customers’ operations and supporting a wider range of their needs.
  • New research in The American Journal of Tropical Medicine and Hygiene provided more evidence in support of point-of-care ultrasound’s effectiveness in low-resource regions. The researchers trained six mid-level care clinical officers (COs) in South Sudan to use POCUS, who each performed 60 POCUS lung studies on <5-year-old children with suspected pneumonia, finding 99.1% of their images to be acceptable and 86% of their interpretations to be appropriate. However, the average exam lasted 15 minutes, far longer than the 7-minute average found in previous research.
  • New research in Radiology explored the reasons that some coronary CT angiography studies weren’t of high enough quality to be used in FFR-CT analysis (previously reported to have 13% to 33% rejection rates). The retrospective study (n=10,416 patients’ CCTA scans) showed relatively low FFR-CT rejection rates (2.9% with ADVANCE registry cohort, 8.4% with clinical cohort) with rejections largely due to image quality issues (primarily motion artifacts: 78% in ADVANCE cohort, 64% in clinical cohort), the use of older technology (dual source and wide-coverage single-source CTs had much lower rejection rates), greater CT section thickness, and higher patient heart rates.

The Resource Wire

– This is sponsored content.

  • This Nuance blog details how VIDA’s AI-driven LungPrint Discovery tool, integrated with Nuance’s PowerScribe One reporting platform, can cut the time it takes to interpret a study with a greater understanding of the underlying patient condition.
  • Carestream’s first OnSight 3D customer, Resurgens Orthopaedics (24 locations, 104 physicians), shared some of the benefits they’ve experienced from the cone beam CT system in this video, including the importance of weight bearing in surgery decisions, and the system’s image quality, ease of use, and fast study time.
  • How much does a CT scan cost? According to Medmo, that depends. Scans made with the exact same device on the exact same body part could cost $225 at one facility and $2,500 at another. Medmo also provides some advice to make sure patients don’t overpay for their scans, including using the Medmo Marketplace, where the average CT costs between $225 and $700.

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