NHS Transformation Plan | Radiology’s 8% to 9% Cut

“There are a variety of winners and losers here. Endocrinologists will gain 16% in reimbursement, but radiologists will lose 8% to 9%.”

The ACR’s Cynthia Moran on how radiology came out a loser in CMS’ 2020 Medicare Physician Fee Schedule.

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The Imaging Wire

NHS Transformation Plan

The UK NHS revealed an ambitious plan to reorganize its imaging/radiology facilities across England into collaborative imaging networks aligned according to clinical focus (e.g. cancer, stroke, major trauma). Here are some details behind this pretty big change:

New Networks – The new collaborative imaging networks (24 networks in 2022, streamlined to 18 networks by 2023) are mainly intended to have the right technologies and skills for their targeted clinical areas at each facility (or at least within the same network).

Focus & Efficiency – Noting the NHS’ challenges with device/clinician downtime in its current non-specialized structure, this network-based refocusing will help facilities keep up with clinical demand, improve diagnostic speed/accuracy, and better manage system upgrade plans (because their devices and skills are relevant to their patient volume).

Patient & Staff Value – The networks will also help combat cost variations between different trusts, improve local access to clinical expertise within each specialized network, improve workflow, and give staff new opportunities to build their careers.

Scaling AI – Those who read down to page 26 of the plan will find that the networks are also intended to support AI adoption at scale, which some might argue would be an industry first and among the most intriguing parts of this overhaul.

Radiology’s 8% to 9% Cut

Despite massive radiology industry efforts to avoid changes to outpatient Evaluation and Management (E/M) Services coding, the final Medicare Physician Fee Schedule for 2020 indeed included E/M coding changes that the ACR forecasts will cost U.S. radiologists $5.6 billion over the next decade (starting Jan 2021). Here are some details:

Evaluation and Management – The E/M changes would actually result in $5b in additional provider reimbursements, but this increase will largely go to other specialties and would require cuts in other areas due to CMS’ budget-neutral mandates. Radiologists are high on this list of impacted specialties, given that they rarely bill E/M codes. Although CMS estimates that radiologists will see reimbursements fall by 8%, the ACR estimates that payments will fall by 9% or more. Someone has to pay for endocrinologists’ 16% increase.

ACR’s Recourse – The ACR is still working on this, revealing plans to work with Congress “to suspend the budget neutrality requirement” and “modify the impact of these changes.” This may be the best available path for radiology given that the ACR doesn’t expect CMS to change its position on E/M coding during the final comment period. However, the ACR doesn’t seem very encouraged that Congress members would easily adopt this issue during an election year, so a reversal before 2021 could be a longshot.

The Wire

  • A team of UK researchers revealed that a blood test capable of detecting signs of breast cancer five years before clinical symptoms develop could be publicly available by 2025, as long as development is fully funded. The team already completed one blood test study (n= 90 bc patients, 90 control) to measure autoantibody markers produced in reaction to tumors, correctly detecting breast cancer in 29% of the breast cancer patients and marking 84% of the control group’s samples as cancer-free. The team is now testing samples from 800 patients for nine predictive biomarkers and expect this study to result in greater accuracy. Although still in development (along with other tests for pancreatic, colorectal and liver cancers), the researchers view the blood test as a lower-cost and easier option versus mammography, especially suitable for low- and middle-income countries.
  • New research in AJR revealed more details on emergency imaging’s massive growth. Looking at data from 2004 to 2016, the study found that although Medicare patients’ ED visits increased by 8% (20m in 2006 to 21.6m in 2014), ED imaging exams from the same group increased by a much higher 38.4% (14.6m to 20.2m). This growth was largely driven by CT +153.0% (77.8 in 2004 to 196.7 in 2016), non-cardiac ultrasound +134% (11.2 per 1k in 2004 to 26.2/1k in 2016), and radiography +30% (259/1k in 2004 to 361/k in 2016).
  • Five months after a Boston University team first announced a new metamaterial that can increase the imaging power of lower-strength MRIs and cut scan times in half, an update from scientists released some impressive improvements. A new paper reveals that the coupled nonlinear metamaterial (NLMM) now improves signal-to-noise ratio by 10-fold (previously 4.2x) and can be produced for less than $10 (previously not discussed).
  • A new Philips survey brought attention to alarming levels of burnout among technologists (n=254 RTs & imaging directors in US, UK, France, Germany), revealing that many RTs have moderate to severe career stress (US=44%; UK=54%; FR=40%; GER=97%) and moderate to high burnout rates (US=36%; UK=30%; FR=33%; GER=97%), blaming “workload” as the top RT stress/burnout driver (US=40%; UK=67%; FR=50%; GER=95%). Although there’s been plenty of coverage of radiologist burnout, this is one of the few studies on RT burnout, revealing a need for greater efficiency across radiology departments and roles.
  • New research in Clinical Radiology revealed that radiology has a UK med student perception problem, as a survey of 328 undergraduate medical students ranked Radiology 10th out of 14 specialties due in part to its perceived “low status.” Radiology’s “low status” ranking was based on the students’ interpretation of how radiology is perceived by the public and other clinicians, expected patient contact levels, limited work variety, and work environment. The study suggested that medical students weren’t completely aware of the range of radiologists’ work, which may not surprise some reading this, and suggests that more undergraduate radiology exposure might improve perceptions.
  • A report from IMV Medical Information Division detailed on AuntMinnieeurope.com added some positive news to one of the more negative Imaging Wire issues in recent memory. The firm found that radiologists worldwide (n=300) remain optimistic that medical imaging procedures volume will continue to grow (80% expect more imaging in 2019 vs. 2018), with the greatest increases expected in emerging markets. Only a quarter of the respondents believe their facilities have the capacity to meet demand two to three years from now, so 87% expect to purchase new systems (led by CT and MRI) and 70% will prioritize workflow/productivity improvements in the coming years.
  • Frost & Sullivan released a brief on how healthcare providers can drive growth and achieve greater scale from their imaging service lines, encouraging a strategic focus on technology management (acquisitions, fleet management, vendor engagement), enterprise integration (physician alignment, operating plans, clinical collaboration), cost-efficiency, and business growth (referrals, catchment expansion, negotiation leverage). You’ll have to trade your email address and other info to access this brief, but it’s graphical and pretty useful if this is your focus area.

The Resource Wire

  • Did you know that imaging patients are most likely to no-show for their procedures on Mondays and Saturdays? By partnering with Medmo, imaging centers can keep their schedules full, despite the inevitable Monday no-shows.
  • Catch Nuance’s Karen Holzberger and Woojin Kim, MD in this radiologytoday.net article, where they share how AI app marketplaces are bridging the gap between AI creators and users.
  • This spotlight details how the Sunnybrook Research Institute pioneered focused ultrasound and became the word leader in FUS clinical trials.
  • Headed to RSNA 2019? Qure.ai will present four abstracts at the conference 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.

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