Walmart-Approved Imaging | Density Debate | A Path to Patient Consultations

“The question of whether Machines Can Think is about as relevant as the question of whether Submarines Can Swim.”

A 35-year-old quote from Dutch computer scientist, Edsger Dijkstra, that Curtis Langlotz used in his latest paper reassuring that AI will not replace radiologists.

Imaging Wire Sponsors

  • Carestream – Focused on delivering innovation that is life changing – for patients, customers, employees, communities and other stakeholders.
  • Focused Ultrasound Foundation – Accelerating the development and adoption of focused ultrasound.
  • Medmo – Helping underinsured Americans save on medical scans by connecting them to imaging providers with unfilled schedule time.
  • Nuance – AI and cloud-powered technology solutions to help radiologists stay focused, move quickly, and work smarter.
  • Pocus Systems – A new Point of Care Ultrasound startup, combining a team of POCUS veterans with next-generation technology to disrupt the industry.
  • Qure.ai – Making healthcare more accessible by applying deep learning to radiology imaging.

The Imaging Wire

Walmart Sees the Value in Quality
Walmart’s world-class data analytics operations may be best known for things like managing logistics and optimizing product assortments, but the retail giant’s latest discovery led to a big change in how and where its employees get their medical imaging scans. After realizing that about half of its employees who underwent back surgery in recent years didn’t actually need surgery, with imaging misdiagnoses as the main culprit, Walmart now recommends that its employees and their dependents get scanned at one of 800 approved imaging centers. Walmart employees won’t be forced to go to these centers, but those who don’t will have to pay more for their scans.

These 800 Walmart-approved imaging centers were provided by Covera Health, which analyzed thousands of hospital-based and outpatient imaging facilities, using audits from independent radiologists combined with statistical modeling to identify the highest-quality providers. The analytics firm will continue to monitor these centers and is working to identify 700 additional approved imaging centers by the end of 2019.

Although large employers directing their staff to use approved healthcare providers is quite common, this appears to be the first initiative to select imaging providers based on their accuracy, rather than cost. Given the complexity of advanced imaging and the costs that Walmart faces with every unnecessary surgery, focusing on diagnostic quality seems pretty smart.

Debating Density Notifications
A new JAMA Viewpoint article called into question whether the U.S. federal government’s newly-passed breast density notification law will actually help patients. The authors recognized the law’s patient awareness upsides, but challenged the scientific evidence supporting density notification laws and warned of numerous unintended consequences.

The Viewpoint article cautioned that nationwide density notifications will drive increased patient confusion and anxiety and result in more false-positives and unnecessary biopsies. The authors also challenged the belief that supplemental imaging for women with dense breasts actually improves cancer outcomes and even questioned whether radiologists can accurately or consistently identify whether women have dense or nondense breasts.

Although this politically-popular law is unlikely to be stopped, the article called for physicians to take the lead on discussing density with their patients and encouraged improvements in the way notifications are written to mitigate the drawbacks that may come from the upcoming wave of density notifications.

A Path to Patient Consultations
With demand for radiology consultations growing among both patients and radiologists (some rads anyway), a new JACR editorial outlined the challenges that radiology consultation clinics face and shared some potential solutions.

  • Challenges – Radiology consultation clinics’ adoption barriers are pretty clear, given radiologists’ high productivity requirements, the fact that they bill for readings (not consultations), and the likelihood that radiologists aren’t reading scans at the same location as their patients.
  • Solutions – The expansion of radiologist-patient consultations would largely rely on changing how radiologists are compensated, including positioning consultations as value-added work, and potentially requiring patients to pay for consultations out-of-pocket. However, significant compensation changes would require equally significant adjustments to reimbursement policies.

Making radiology consultation clinics a common part of the healthcare system won’t be easy, but this article is at the very least a helpful conversation starter. It’s also relevant given the popular belief that AI will give radiologists more time for patient care and the growing evidence that many patients desire more radiologist interaction.

Q1 Imaging Financials Wrap-up with More Mixed Results
The second wave of medical imaging company financials from the January-March 2019 period hit the press, revealing a strong performance from Fujifilm, but mixed-to-down performances from Konica Minolta, Shimadzu, and Varex. These results follow similarly-mixed Q1 financials that came out earlier this month, after imaging players posted mainly positive results throughout 2018.

  • Fujifilm – Despite slightly lower revenue (down 1.9% to ¥2.43t/$22.1b) during FY2019, Fujifilm achieved record-high operating income (up 70% to ¥209b/$1.9b) and net income (up 8.9% to ¥157b/$1.4b) due to its strong healthcare performance (revenue up 9.3% to ¥483b/$4.4b, OP up 67% to ¥33.3b/$303m) and significantly improved printing margins (up 11.5x to ¥97.6b/$890m). Fujifilm’s fiscal fourth quarter included a slight increase in revenue (up 1.3% to ¥631b/$5.7b) and a major improvement in net income (up 4.1x to ¥42.7b/$389m).
  • Konica Minolta – Konica Minolta recorded a decent FY2018 (revenue up 3% to ¥1.05t/$9.6b, OP up 16% to ¥62.4b/$569m), but stumbled during its fourth quarter (revenue flat ¥281b/$2.56b, OP down 52% to ¥11.9b/$108m). The slowing DR market led to a challenging FY2018 for Konica Minolta’s healthcare business in FY2018 (revenue up 6% to ¥90.9b/$829m, OP down 57% to ¥2.4b/$21m) as well as a soft Q4 (revenue up 1% to ¥29.8b/$272m, OP down 28% to ¥1.2b/$10.9m).
  • Shimadzu – Shimadzu reported a decent FY2018/19 performance (revenue up 3.9% to ¥392b/$3.5b, OP up 3.9% to ¥44.48b/$405m), while its medical unit grew revenue (up 4.8% to ¥69b/$629m) but reported a notable drop in operating profit (down 13.8% to ¥2.32b/$21m) due to low DR demand.
  • Varex – Varex announced a “strong” fiscal Q2, but still saw declines in revenue (overall down 3% to $196m, medical down 6% to $149) and operating profit (down 11.7% to $15m).

The Wire

  • Zebra Medical Vision announced the FDA clearance of its HealthPNX product, which automatically reads chest X-rays to detect and prioritize cases with pneumothorax, and can reduce treatment time for acute conditions by over 80%. HealthPNX is the result of Zebra’s previously-developed Radbot-CXR algorithm (reads CXR exams) and Textray solution (extracts labels from radiology reports) and integrates with the company’s “All in one” (AI1) radiology workflow solution.
  • The conventional wisdom that MRI exams are higher-cost than ultrasound isn’t always true, at least according to a Texas Children’s Hospital team that found ultrasound to be the lower-cost solution for diagnosing adolescent female patients with suspected appendicitis. The researchers created process maps for US and MRI pathways (n= 231 and 52 patients, respectively), finding that ultrasound diagnosis took 91 minutes longer than MRI (166 vs. 75 minutes) and generated nearly $50 higher average costs per patient ($258.33 vs. $209.97) when capacity costs are multiplied by time requirements.
  • Aidoc announced the FDA clearance of its Pulmonary Embolism (PE) solution, which helps radiologists flag and triage PE cases in chest CTs, calling it the “world’s first AI solution for flagging pulmonary embolism.” Aidoc placed a significant focus on its overall AI platform in the announcement, noting its solution pipeline (2 cleared in last six months, 8 in clinical trials) and its goal to develop a scalable AI platform that contributes across radiologist workflows.
  • Neural Analytics completed a $22 million Series C round, increasing its total funding to $66 million, and allowing the company to expand its Lucid Robotic System into clinical environments. The Lucid Robotic neurological ultrasound system combines Neural Analytics’ NeuralBot system (automatically adjusts ultrasound positioning) and Lucid M1 Transcranial Doppler Ultrasound system to triage neurological diseases.

The Resource Wire

  • 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.
  • 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.
  • The Focused Ultrasound Foundation’s 2018 Year in Review details the impressive research and clinical achievements that took place last year.

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