MPFS’ Good News | Neuroimaging Overused | The Bureaucratic Beast

“The head is a black box, and it’s a scary black box. In the absence of having guidelines with regard to imaging, the natural tendency is to want to do everything.”

Oregon Health & Science University’s Martin Salinsky, MD, explaining that even though his research finds emergency departments may overuse neuroimaging with epileptic seizure patients, it’s because of missing guidelines not ED recklessness.



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Radiologists Should Feel Okay About MPFS 2019
As expected, CMS’ 2019 Medicare Physician Fee Schedule (MPFS) spared radiology from major Medicare cuts, keeping reimbursements for radiology unchanged, while slightly reducing nuclear medicine (-1%), and increasing payments for interventional radiology (+2%). The decision eases concerns that arose after the Medicare Payment Advisory Commission (MedPAC) recommended that congress reduce Medicare reimbursements for radiology by 3.8%. The final CMS ruling also confirms that in 2019 radiologist assistants will be able to perform diagnostic tests (under radiologist supervision) and made it official that in 2020 physicians will have to include appropriate use criteria when ordering advanced imaging.


Epilepsy Neuroimaging Overused
Research from Oregon shows that emergency departments may overutilize neuroimaging scans. The study looked at 882 seizure-related ED visits by patients who were already diagnosed with epilepsy, finding that 46% of all patients received a neuroimaging scan during their visit (381, mostly CT), with just 10% of scans (41) revealing a new clinical problem and only 2% of scans leading to an acute change in management (9, two were false positives). Noting that 90% of these patients had previous neuroimaging results available (with most results less a year old) and that the nine cases that led to acute changes were due to three very defined situations (head trauma, prolonged alteration of consciousness, focal neurological exam), the researchers found that “absent any of those three factors, . . . the yield [of CT] was essentially zero.” In fact, the researchers suggested that many of these patients didn’t even need to go to the ED, nevermind receive scans. However, the researchers were sure to clarify that they don’t blame the ED doctors, instead pointing out that the American Academy of Neurology hasn’t published guidelines for patients who’ve had a prior seizure diagnosis.


A Different Perspective on Imaging’s Value
Here’s the new perspective amid the weekly flow of imaging overuse stories. Research from the University of Washington in Seattle found that patients view learning about their imaging results as a valuable part of their healthcare journey, even if the results do not impact their treatment. The research found that patients want to understand their situation and appreciate diagnostic certainty, suggesting that other studies focused on imaging overuse may not take into account how patients define “value.”


Visla Labs Targets the Bureaucratic Beast
Medical imaging diagnostics AI startup, Visla Labs, completed a $3 million seed round that it will use to grow its team, enhance its radiology diagnostics platform, gain regulatory approval, and eventually “reimage the process of radiology.” Visla Labs’ platform aims to help teleradiology firms and urgent care centers deliver diagnosis at significantly lower costs and with faster turnaround times than standard methods, leveraging its self-improving AI engine and one-click installation as core components of its solution. Visla Labs already enjoys decent cachet due to its founders’ big-name origins (Apple, Twitter, Stanford) and appears to be trying (hard) to position itself as an disruptor, particularly through outsider-themed messaging and Erlich Bachman-esque quotes (we really like this one: “. . . empowering the practitioner not feeding the bureaucratic beast of status quo healthcare IT,”), making it an interesting company to watch as we head into 2019.


Q3 Financial Season off to Mixed Start
The first round of medical imaging company financials from the July-September period hit the press, revealing mixed results from Canon, GE, Hitachi, and Philips.



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  • A Dutch study (n=114) found that 4D flow MRI with automated cardiac valve tracking achieves valvular flow quantification faster (14 min. vs. 25 min.) and more reliably (4.9% variation vs. 9.8%) than manual valve tracking.



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