Fogo AB et al, writing about the threat of AI to kidney pathologists in a letter in JAMA.

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Out-of-Network Radiology Claims Fall

Is out-of-network billing – when a patient receives care outside their insurance network – still a problem in radiology? A new study in JACR shows that out-of-network commercial claims have dropped dramatically since 2007.

Out-of-network healthcare has been the focus of a number of legislative efforts in recent years as lawmakers try to protect patients from the financial sting of getting a big bill for services rendered outside their provider’s network.

• Probably the centerpiece of this effort is the federal No Surprises Act, which went into effect in January 2022; not only did it cap the amount that patients can be billed for out-of-network services, but it created an independent dispute resolution mechanism for adjudicating disagreement between providers and payors over how much they should be paid.

The IDR mechanism has been the focus of legal wrangling in recent months, but the new study in JACR indicates that it might not be getting much use after all, at least in radiology.

Researchers from the ACR’s Harvey L. Neiman Health Policy Institute analyzed 80M commercial claims for radiology services from 2007 to 2021, finding…

• Out-of-network radiology claims fell dramatically (to 1.1% vs. 13%)
• Out-of-network claims fell for inpatient stays (to 1.4% vs. 10%)
• Claims also fell for emergency visits (to 0.4% vs. 3.9%)
• By modality, most claims were for X-ray (57%), followed by ultrasound and CT (15% each) 
• By 2021, radiologists practiced almost exclusively in-network

What’s the reason for the dramatic decline? The study authors credit good-faith negotiations between radiology practices and commercial payors, as well as the impact of state surprise billing laws (the study period occurred before the federal No Surprises Act went into effect).

• Other possible factors include consolidation among practices, hospitals, and payors; expansion of academic centers into communities; and the COVID-19 pandemic.   

The Takeaway

The JACR study is welcome news for both patients and radiology practices. Patients are less likely to be hit with surprise medical charges, while practices are less likely to have to fight through the IDR process to resolve claims. In the end, everybody wins – even insurance companies.

The Case for Enterprise Cloud

Is your organization ready to move enterprise imaging to the cloud? Check out this Change Healthcare and ACHE webinar detailing cloud-native imaging’s benefits, best practices, and ROI.

Experience the Healthcare Revolution

Did you experience the healthcare revolution with United Imaging at RSNA 2023? From the uAIFI Technology Platform to the uDR 380i Pro mobile X-ray system, check out how United Imaging technologies are reshaping healthcare in this video.

The Wire

• AI Threat to Doctors?  Amid the positive news over AI’s impact on radiology comes a bombshell dropped by kidney pathologists in an opinion piece published last week in JAMA. Under the title “AI’s Threat to the Medical Profession,” the authors claim that AI poses a threat by replacing human pathologists for interpreting tissue specimens. They see AI reducing pathology work to an “input/output” function in which knowledge of disease development is forgotten and lost. They see the Biden Administration’s recent AI executive order as an opportunity for physicians to regain control.

• Bloomberg to Fund Allied Health Training: Billionaire philanthropist Michael Bloomberg is donating $250M to fund education and training of high school students for careers in allied health professions, including as radiologic technologists. Bloomberg Philanthropies has matched health systems with high schools across the US to provide specialized healthcare classes in addition to traditional academic courses. Students will participate in job shadowing and have access to paid internships, and on graduation will be able to go straight to work with the partner health system or continue their education.  

• Interventional Radiation Dose: The rising number of interventional radiology procedures is prompting concern over occupational radiation dose. In a new study in Radiography, researchers from Denmark and Norway measured radiation dose to staff for 99 interventional procedures; prostate artery embolization exposed radiologists to the highest dose (median of 15 µSv) with wide variation (0.2-153 µSv). Except for uterine fibroid embolization, dose exposure for radiologists was higher than for radiographers (radiologic technologists). Fortunately, doses measured were lower than a 2017 study (33 µSv), indicating proper use of lead shielding.

• PE Firm Buys RadSource Stake: Private equity fund HealthEdge Investment Partners has bought a stake in Radsource, a provider of subspecialty orthopedic and neurology MRI interpretations with 25 fellowship-trained radiologists. Radsource also offers the ProtonPACS software, launched in 2012 through a partnership with Intelerad. 

• Study Supports 3D ABUS: 3D automated breast ultrasound – particularly for women with dense breast tissue – is supported in a new study in European Radiology. Researchers used DBT and Siemens Healthineers’s Acuson S2000 ABVS system from 2014 to 2022 to screen 1.6k women, 96% with dense breast tissue (Volpara category C or D). Malignancies were found in 2.4% (27% found only on ABUS), with a recall rate of 5.2%, which declined over time. The cancer detection yield was 2.77 cancers per 1k screening tests.   

• Hackensack Adopts Volpara Software: New Jersey health system Hackensack Meridian Health has adopted Volpara Risk Pathways software to help identify and manage patients who are at high risk for breast cancer. The solution generates a risk assessment based on mammography exams that enables physicians to create customized screening plans for women. It also facilitates integration with genetic counseling and patient tracking that’s available throughout the health system. Volpara agreed to be acquired by Lunit in December.

• Qure Partners on Tumor Assessment: Qure.ai has signed a partnership with Project Data Sphere that will employ Qure’s technology as part of tumor assessments in research studies and clinical care. Qure’s algorithms will be used as part of the project’s autoRECIST, a tool for analyzing medical images to determine the effectiveness of pharmaceuticals being developed by measuring tumor size. In other Qure news, another NHS Trust has joined the LungIMPACT study, which is using the company’s qXR software to triage chest X-rays for suspected abnormalities. 

• Riverain Signs NoLa Hospital: Riverain Technologies has landed University Medical Center New Orleans as a customer for its ClearRead CT with Clear Visual Intelligence for the detection of lung nodules in chest CT scans. The hospital is the academic medical center of the LCMC Health network of providers in southern Louisiana, and joins University of Texas Medical Branch among recent Riverain installations. 

• New Google AI Outperforms PCPs: Google announced a new AI system called Articulate Medical Intelligence Explorer – AMIE – tuned for diagnostic reasoning and conversation. It outperformed PCPs in testing with patient actors, beating human doctors in 24 of 26 conversational measures (i.e. empathy, bedside manner), as well as all six diagnostic categories. The authors pointed out that diagnostic dialog requires a high level of context and clinician skill, and that the simulated conversations likely underestimate the value of human conversations.

• Annalise Lands Middle East Distributor: Annalise.ai has boosted its distribution in the Middle East through a deal with Emerging Global Technologies. EGT has been appointed an authorized distributor for Annalise solutions in the United Arab Emirates and other countries in the Gulf Cooperation Council. Annalise has been building up its distribution network of late, such as through a recent deal with Avreo. 

• Us2.ai’s Echo AI Platform Play: Last week’s news of Children’s National and Us2.ai’s rheumatic heart disease screening initiative, also revealed Us2.ai’s promising new pathway for bringing custom echo AI applications into widespread clinical and commercial use, which is historically a challenge for algorithms produced by health systems and academic institutions (or even smaller startups). In this case, Children’s National was able to leverage Us2.ai’s proven echo AI software platform to deploy its RHD algorithm across the Ugandan screening program, but Us2.ai’s platform approach could apply to a far larger list of echo solutions and clinical challenges.

• Blackford Adds Prostate AI: Blackford continues to build out its Platform enterprise AI offering, this time adding the ProstatID solution from Bot Image. ProstatID assists radiologists as a concurrent reading aid in the detection, assessment, and characterization of lesions suspicious for cancer on prostate MRI scans. With the deal, Platform now offers over 115 medical AI algorithms, including recent additions See-Mode and Rayscape. 

• Ultromics and Pfizer’s Amyloidosis Alliance: Echo AI company Ultromics announced a partnership with Pfizer to support the development and FDA clearance of Ultromics’s echo AI algorithm for cardiac amyloidosis detection. Ultromics’s EchoGo Amyloidosis AI analyzes routine echocardiograms to identify patients with cardiac amyloidosis, and gained FDA Breakthrough Device Designation in April 2023. The alliance is another example of pharma companies partnering with AI developers to improve detection of treatable patients, following similar partnerships between Anumana and Pfizer (ECG AI for cardiac amyloidosis) and Viz.ai and BMS (ECG AI for HCM).

• ViewRay Mystery Buyer: Bankrupt radiation oncology vendor ViewRay appears to have found a buyer. ViewRay filed for Chapter 11 in mid-2023, then in October converted to Chapter 7 as it moved to liquidate its assets. But unconfirmed reports late last week indicate that the company was acquired by “a private entity” that remained undisclosed as of press time. A deal would be a lifesaver for ViewRay customers, many of which shelled out up to $6M for the company’s MRIdian MR-guided linear accelerator radiation therapy system.

Drivers of AI Usage in Radiology

Radiologists are being asked to read more, read faster, and with a higher degree of accuracy as imaging data grows in volume and complexity. In this video, listen to Bernardo Bizzo, MD, and Riverain CEO Steve Worrell explain how this is driving AI usage.

The Right Approach to AI Adoption

Discover the right approach to AI adoption and the transformative impact of CARPL.ai in accelerating the clinical implementation of AI, driving ROI, and revolutionizing patient care in this video featuring leaders from Radiology Partners and University Hospitals, Cleveland.

Give Your Patients the Experience They Want

Empower patients to take control of their healthcare journey by giving them mobile access to their records and images with Clearpath, the world’s first digital fulfillment platform for records and films. Book a demo today.

The Resource Wire

• Nuance’s PIN Helps Identifies Emphysema: Emphysema is often underdiagnosed, and this can make treatment more difficult. FirstHealth of the Carolinas was able to improve its diagnosis of emphysema and enhance its CT lung screening service with AI algorithms available through Nuance Precision Imaging Network (PIN).

• The Big Picture at Intelerad at RSNA 2023: What was in the big picture at Intelerad Medical Systems at RSNA 2023? Check out this video interview with President Morris Panner about the company’s accomplishments in 2023 and its plans for 2024, including a big focus on image exchange.

• Your Single Solution for AI, 3D, and Full Interoperability: Realize immediate value across your organization with subscription-based advanced visualization and AI from TeraRecon that accelerates imaging workflows and improves patient outcomes. Schedule a demo today. 

• Take the Lead in Fracture Detection: A recent review by University College London highlighted essential factors for selecting the right AI tool for fracture detection, with Gleamer’s BoneView emerging as a standout performer. Dive deeper into the research to learn more. 

• Benefits of AI for Radiology: What’s the biggest benefit that you expect from AI in your daily radiology practice? Is it worklist prioritization, improved detection, or something else? Participate in this poll from Calantic by Bayer to make your voice heard.

• What Does Improved MRI Efficiency Mean? There’s a growing need for practical, cost-effective solutions to improve efficiency in MRI and other modalities. Read this article from Karen Holzberger of SpinTech MRI and James Backstrom, MD, to learn how the company’s STAGE software can help. 

• The Intersection of Health Technology and Business: How are the worlds of health technology and business intersecting? In this episode of The Radiology Report, Intelerad Medical Systems President Morris Panner sits down with Medality CEO Daniel Arnold to explore his career and discuss the evolution of the industry.

• Home-Based Cardiac Ultrasound: How is home-based AI-aided cardiac ultrasound poised to change global healthcare? In this article from Us2.ai, hear from Izabella Uchmanowicz, RN, on how the CUMIN study is empowering nurses to perform AI-POCUS. 

• The Journey to Cloud-Based PACS: Radiology is looking closely at cloud-based PACS as an alternative to on-premises digital image management. We discuss this emerging trend with key opinion leaders who have made the switch with Visage Imaging in The Imaging Wire Show.

• Discover How to Unlock Dual-Source CT: Discover how dual-source CT technology from Siemens Healthineers delivers the temporal resolution and scan speed needed to reduce motion articles, and how the company is making dual-source CT available to a wider range of hospitals and imaging centers.

• Make Health Smarter with Merge: Address your imaging needs today and face the future with confidence with Merge by Merative. Learn more about enabling better outcomes for your physicians and patients with Merge Imaging Suite.

• How Your Imaging Tech Affects the Entire Enterprise: Join Konfidi Healthcare President Brandon Taggart and Enlitic’s Dave Wilson in a conversation about medical imaging technology. Dive into the key points and get your questions answered during this 30-minute webinar on January 25.

• Major Milestones in Platform AI: It was a busy year for AI platform developer Blackford. We reviewed the company’s major milestones in this video interview from RSNA 2023, in which we talked to Blackford executives David Hilderbrand and Anthony Cammack. 

• Cancer Care with Data-Driven Diagnostics: There is growing awareness that greater collaboration to show data can provide clinicians decision support for providing the right treatment to enhance patient care and outcomes. GE HealthCare shares more on how they are looking at cancer care with data-driven diagnostics and treatment.

• Patient Centricity and Breaking Down Barriers to the Quadruple Aim: Watch this panel hosted by PocketHealth at RSNA where industry leaders discuss the advantages of a patient-centric approach to image exchange. Explore its positive impact on quadruple aim goals, including population health, patient experience, avoiding revenue loss and increasing staff wellness.