Surprise Billing, Quantified | fxPET Progress | Australia’s National Images

“Our foreign investment laws only allow foreign investments where we don’t think it’s contrary to the national interest.”

Australian Prime Minister, Scott Morrison, discussing the role of “national interest” in whether a Chinese company will be allowed to acquire the imaging provider that happens to handle the country’s military.

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The Imaging Wire

Surprise Billing, Quantified

There’s no doubt that surprise billing has found its way into the legislative and media spotlight in recent months. A Stanford-led team just delivered the strongest evidence yet that it belongs there:

  • The Study – The retrospective study (5.45m inpatient and 13.58m ED admissions) revealed that the incidence and average cost of out-of-network billing increased for both ED admissions (32.3% to 42.8%, $220 to $628) and inpatient admissions (26.3% to 42.0%, $804 to $2,040) between 2010 and 2016.
  • The Takeaway – Out-of-network billing has become more common and more costly for privately-covered patients, even when they’re treated at in-network hospitals (specialists like radiologists and anesthesiologists are often billed as out-of-network physicians).

fxPET Progress

Physicsworld.com published a study on Shimadzu’s in-development fxPET scanner (flexible PET), a mobile PET scanner designed to fit into an existing MRI or CT system that could serve as a lower-cost way to add PET/MRI to existing fleets. Here’s what they found:

  • The researchers scanned 59 patients with various cancers using a whole-body PET/CT system, followed by a pair of MR-compatible fxPET scans configured with the detectors at different distances from the patient.
  • The fxPET scans performed with the detectors positioned closer to the patients identified more lesions (172/184) than fxPET scans with the detectors set further from the patient (169/184) and the whole-body PET/CT (166/184).
  • The fxPET scans also had larger standardized uptake value (SUV) and smaller metabolic tumor volume (MTV) than whole-body PET/CT, especially for lesions smaller than 2 cm.

This is the latest fxPET study performed by this Kyoto-based team (here’s one from last year), and although the fxPET system isn’t yet ready to launch, they’re making progress. Next up are studies to evaluate a new fxPET reconstruction algorithm and to determine the system’s most appropriate scanning time.

Australia’s National Images

Geopolitics made Australia’s medical imaging news a bit more interesting this week, as China’s Jangho Group reiterated its plans to buy major Australian pathology and imaging service company Healius (the country’s #2 imaging center).

  • Jangho’s Second Try – Jangho Group already owns 15.9% of Healius and made an unsuccessful $2b bid for the company in January, but recently reiterated that it “intends to acquire Healius in the future.”
  • A National Security Issue – This became a national security issue due to Healius’ relatively new role as the Australian Defense Force’s medical imaging provider, which gives it access to years of data on the country’s military personnel (identifiable information, referral notes, pathology results, images and radiology reports). Not to mention, Jangho is firmly connected with the Chinese Communist Party.
  • Executive Intervention – Some in the country are not interested in handing over this information to the Chinese, including Prime Minister Scott Morrison, who said that the Australian Foreign Investment Review Board may intervene if the acquisition is against “national interest.”

This story is technically about Australia and China but the idea of diagnostic reports becoming a geopolitical asset is notable, especially in the age of AI and considering the global expansion of Chinese imaging players.

The Wire

  • The UK NHS will establish a £250m national artificial intelligence lab, bringing together academics, specialists, and technology companies with the goal of expanding the role of AI in healthcare. That’s a pretty broad goal, but so is the NHS AI Lab’s range of focus areas, including improving cancer screening, developing new dementia treatments, forecasting healthcare demand, and allowing more personalized care (among others). The lab will be part of NHSX, a new organization overseeing the UK healthcare system’s digitization, and it represents a key step in the NHS’ AI-focused Long Term Plan.
  • Wipro became the latest technology giant to get into the imaging AI game, launching three Intel-based edge AI starter solutions intended to help companies “in the Energy & Utilities and Healthcare markets jump start their AI adoption.” The company’s Medical Imaging Starter Solution uses AI to identify regions of interest and label abnormalities in X-ray and CT scans.
  • A Pennsylvania state appeals court refused to overturn a 2018 conviction or $32.5k fine against a family physician who had an unlicensed assistant perform X-rays in violation of the state’s Radiation Protection Act. The doctor argued that the conviction should be overturned because the Radiation Protection Act is “unconstitutionally vague” (specifically the use of the term “bodily harm”) and allows for “arbitrary enforcement,” but the court disagreed.
  • A New York state jury awarded a massive $56 million malpractice verdict to a 67-year old woman and her husband after a botched herniated disc spinal surgery left her paralyzed below her neck over 10 years ago. A Hudson Valley Neurosurgical Associates took the brunt of this verdict, as they allegedly damaged the woman’s spinal cord during surgery but blamed it on a coincidental stroke even after radiologists found an epidural hematoma in a follow-up CT. The radiology firm involved already settled for $5.6 million as “radiologists and at least one neuroradiologist who viewed an MRI agreed (it) was an infarction.”
  • Since we’re on a roll, a new commentary in RSNA Radiology detailed how and why radiologists will be increasingly expected to disclose errors and apologize to patients, due in part to the threat of legislative actions (patients are less likely to sue if they feel an error was appropriately addressed). Although the commentary is only “calling for further dialog,” it noted that this disclosure and apology practice is becoming increasingly common across medicine (over 200 hospitals require it so far) and radiologists “may soon find the expectation imposed on them by their institution.”
  • University of Oxford spinoff, Oxford Brain Diagnostics officially launched last week, revealing plans to develop a clinical diagnostic platform based on its cortical disarray measurement software (analyzes the brain’s cerebral cortex in MRI scans). Oxford Brain Diagnostics already completed its first funding round and is in discussions with pharmaceutical and biotech companies to support the development of Alzheimer’s drugs and treatments.
  • A survey of breast radiologists (n=312) found that even though most radiologists who use DBT for screening have access to synthesized digital mammography (96% had DBT, 83% had SM), only 52% have replaced DM+DBT screening with SM+DBT screening. The radiologists had relatively mixed perceptions of SM, scoring it 3.4 out of 5 for overall satisfaction and citing SM’s dosage (85%) and lesion conspicuity (27%) advantages, while listing calcification characterization (61%) and image quality (31%) as SM’s disadvantages.

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.
  • Ready for RSNA 2019? So is Carestream, which just shared plans to highlight its 3D extremity imaging systems, DRX room portfolio, DRX Plus Detectors, and DR software at RSNA booth #7513.
  • This Nuance case study details why the Hospital for Special Surgery chose to #ditchthedisk and how they benefited from moving to the Nuance PowerShare Network.

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