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Unpacking 2025 Medicare Changes | Massive Helium Find
July 29, 2024
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Together with
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“It’s like giving a race car less fuel. And expecting it to go faster. We’re not just squeezing doctors. We’re strangling healthcare.”
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Healthcare entrepreneur Dutch Rojas on Medicare reimbursement changes for 2025.
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Imaging Policy & Legislation
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Here we go again. CMS has once again proposed cuts in Medicare and Medicaid reimbursement, and the healthcare community is once again rallying to try to stave them off.
CMS last month released its proposed reimbursement changes for 2025, and there were a few victories for radiology.
- CMS finally agreed to pay for CT colonography, and also agreed to unbundle payments for PET radiotracers from the PET scan itself.
But CMS also proposed changes in the Medicare Physician Fee Schedule (MPFS) conversion factor that continue the slow drip of reimbursement reduction for physicians.
- The agency said the proposal would result in no change for radiology, but a deeper dive reveals that’s not the case.
For example, the analysts at revenue cycle management firm Healthcare Administrative Partners have reviewed the MPFS changes, calculating that if Congressional adjustments are factored in, the outlook is quite different…
- Interventional radiology will see a -5.8% reduction in the imaging center global fee and a -1.8% drop in the hospital professional fee, for a combined decline of -4.8%
- The numbers for radiology and nuclear medicine are -3.8% for imaging centers and -1.8% for hospitals, for combined declines of -2.8%
It may seem like -2.8% isn’t a huge cut, but it continues years of steady declines in Medicare reimbursement (HAP notes that the Medicare physician fee schedule has dropped -10% in the last 10 years).
- And as anyone in healthcare knows, the costs that healthcare practices face have only gone up over that period.
There’s always the chance that Congress will come to the rescue, as it did when it passed the Consolidated Appropriations Act of 2024 – indeed, professional medical groups led by the AMA published a letter last week urging lawmakers to reform CMS’ rate-setting system in several ways …
- Enact an annual payment update tied to inflation
- Eliminate the requirement that changes in payments be budget-neutral
- Overhaul the Merit-based Incentive Payment System (MIPS)
- Make modifications to Alternative Payment Models
The Takeaway
The annual ritual in which CMS proposes sharp cuts in Medicare reimbursement only to have Congress lift them at the last minute is a sort of public policy kabuki dance in which the outcome is practically preordained. Medicare reform is badly needed to end this cycle and put physicians on firmer footing so they can focus on what’s important: caring for patients.
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MRI of the Pelvis and Lower Extremities
Join Donald Resnick, MD, and guest faculty in this Virtual Conference series on MRI of the pelvis and lower extremities, hosted by Medality from September 30-October 4. Register your team and save on your group enrollment.
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Improving Cancer Screening: How AI Empowers Radiologists
Learn how the use of AI-based tools for cancer screening holds immense promise for addressing the lack of trained radiologists in this downloadable eBook from Bayer.
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- Massive Minnesota Helium Find: A massive deposit of helium in northern Minnesota could be even bigger than previously thought and could alleviate concerns over supply of the gas for industrial uses like cooling MRI machines. Recent seismic data show the deposit is larger than previous estimates, which had described its size as “mind-boggling.” Helium is a key element for cooling superconducting MRI magnets, but concerns over shortages – as well as privatization of the US helium stockpile – have prompted MRI manufacturers to develop helium-free versions of their scanners.
- GE Inks Cloud Deal with AWS: Medical imaging vendors continue to link up with cloud providers, with the latest deal involving two giants in both industry sectors: GE HealthCare and Amazon Web Services. GE and AWS are collaborating to train and deploy cloud-based foundation models and generative AI applications for healthcare. GE will use AWS’ Amazon Bedrock managed service to get access to foundation models for building its own generative AI applications, as well as Amazon Q Developer, a generative AI-powered assistant for accelerating software development.
- Mainstream Media’s AI Coverage: Coverage of radiology AI in the mainstream media was mostly positive from 1998 to 2023, but radiologists tend to be underrepresented. Researchers in a new study in Clinical Imaging combed through 25 years of radiology AI coverage, finding that 74% of articles were positive while 9% were negative. The benefits of AI were mentioned more frequently (76%) than the harms (46%), but radiologists were interviewed or quoted in less than one-third of stories – a rate the specialty should try to improve on.
- Gleamer AI Reduces Discrepancies: Gleamer’s BoneView AI algorithm for detecting fractures on X-rays reduced discrepancies between how radiologists and emergency physicians interpreted radiographs. In a pre-publication study of 5.4k patients in France, the solution reduced discrepancies for doubtful fractures by 70% and by 40% for confirmed fractures; it also detected 10 of 22 missed fractures. Reducing differences in interpretation can save ER physicians 28 hours of work each quarter.
- French CT Lung Screening Pilot: France is laying the groundwork to begin a nationwide CT lung cancer screening project. The country’s National Cancer Institute issued a report (in French) that outlines a pilot project to begin in 2025, with broader rollout in 5-10 years. The report notes that lung cancer is the main cause of cancer death in France, with 52.8k new cases in 2023 and only a 20% five-year survival rate. CT lung screening expert Sebastian Schmidt breaks down the proposal in a LinkedIn post.
- Milvue Clearance for Chest AI: In other news from France, Paris-based AI developer Milvue has received its first FDA clearance, for its SmartChest algorithm for chest X-rays. SmartChest is indicated for detecting pleural effusion and pneumothorax on chest radiographs in patients older than 18; it is not indicated to direct attention to a specific area of an image. With clearance in hand, Milvue is targeting the US market, and Milvue CEO Aissa Khelifa will be moving to the company’s Montreal office to lead the effort.
- Radiologist Workforce Shortage: The worsening radiologist shortage has been making headlines recently, but are US radiologists really leaving the field in large numbers? A new study in Radiology suggests that they aren’t: Radiology’s attrition rate from 2019 to 2024 was 13%, at the low end of medical specialties including emergency medicine (27%), pathology (20%), primary care (18%), and surgery (17%). Instead, researchers suggested that not enough new radiologists are being trained, a thought also floated in another recent analysis.
- deepc Raises $13M: Is the dam holding back funding for imaging IT companies starting to break? AI platform company deepc raised $13M in a Series A funding round that brings the company’s total raised capital to $30M. deepc said it would use the funds to accelerate its growth and expand internationally, especially in the U.K. and U.S., where it established a headquarters in Cambridge, Massachusetts in 2023. The company has also been rapidly growing its stable of AI partners.
- Subtle Medical Raises $10M: Subtle Medical joined the imaging IT funding party as well last week, raising nearly $10M in a Series B+ round that brings its total invested capital to over $50M. The company said the funding would be used to promote sales of its medical imaging acceleration products globally and in the U.S.; most recently it launched SubtleSYNTH for synthetic generation of MR images and SubtleREFORMAT for MRI data harmonization.
- Annalise Lands Lumus for TB Detection: Annalise.ai has signed a contract to provide its AI solutions for detecting tuberculosis on X-rays to Australian medical imaging provider Lumus Imaging. Annalise will supply its Annalise Enterprise CXR software to assist Lumus’ 160 staff radiologists with the large volume of TB screening cases they report daily. Lumus operates 150 imaging centers that process over 3M radiography exams annually. Recent studies have found that tuberculosis incidence is rising in developed countries, and AI can improve TB screening.
- Prostate Mapping Payments: Prostate AI company Avenda Health is touting new developments in reimbursement for prostate cancer mapping tools. The AMA has created a new Category III reimbursement code, 0898T, for prostate cancer estimation maps that would also cover use of Unfold AI. Unfold AI measures the extent of prostate tumors by analyzing their margins on MRI scans. The company also said that Medicare contractors can begin billing for Unfold AI exams at rates that vary by geographic region.
- Riverain Lands California Customer: Riverain Technologies has signed a deal with Hill Medical of Arcadia, California to install its ClearRead CT software for detecting lung cancer and other cardiothoracic diseases. The application is being deployed via the Ferrum Health AI platform; Riverain and Ferrum announced a partnership in March 2023.
- Hologic Completes Endomag Buy: Hologic has completed its acquisition of Endomagnetics, a UK developer of breast surgical technology, in a deal originally announced in April. Hologic paid about $310M for the company, which develops breast surgery localization and lymphatic tracing technology and generated $35M in 2023 revenues.
- PET/CT for Breast Cancer: PET/CT with an FES radiotracer that targets estrogen receptors could be an alternative to FDG-PET or CT and nuclear bone scan for women with ER+ tumors. A new study in JAMA Network Open analyzed PET/CT with an FES radiotracer in 124 women, finding no statistically significant differences between FES-PET and the other modalities for detecting distant metastases in women with locally advanced breast cancer or for evaluating suspected recurrence. An editorial called the results “encouraging” and said they support FES-PET for ER+ imaging.
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Automated MSK Measurements
BoneMetrics from Gleamer is an automated AI solution that can help diagnose scoliosis by automating Cobb angle calculations on images acquired with X-ray and EOS systems. Learn more about how it works today.
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Break Down Boundaries in Healthcare
Break down boundaries in healthcare with Intelerad’s InteleShare image sharing solution. InteleShare brings you enhanced access that bridges the gap between care teams and patients to ensure that distance is no barrier to quality care.
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Clearer MRI for Alzheimer’s Disease
Clinicians and patients are encouraged by new drugs available to slow or reduce cognitive decline and Alzheimer’s disease. Learn how 30% faster MRI scans and clearer images enabled by SpinTech MRI’s STAGE software can help address imaging challenges.
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- Building a Theranostics Program: Learn how 210 PET Imaging of Cary, North Carolina became one of the first non-academic outpatient imaging centers in the North Carolina Research Triangle to build a theranostics program in this case study from Siemens Healthineers.
- The Smooth Deployment of Lung AI: Seamless use of AI wouldn’t be possible without workflow integration, made possible in collaboration with hospital IT teams. Learn about the smooth deployment of DeepHealth’s Saige Lung solution at Portsmouth Hospitals University NHS Trust in the UK.
- Streamlining Data Migration: Efficient data management is crucial for delivering quality patient care and achieving organizational goals. But data migration when transitioning to a new PACS can be daunting. Find out how solutions from Enlitic can streamline the process.
- Re-Examining Radiology: A Look to the Future: What will the future of radiology look like? In this downloadable white paper from Optum, learn how a constellation of challenges and pressures have come together to change healthcare – and radiology.
- Fully Automated AI Echo vs. 3D and Human Readers: While 3D echo is becoming more accurate, 2D still dominates clinical care. A new study evaluates agreement in measures of LV volume and function between human readers, echo AI from Us2.ai, and the 3D Heart Model.
- Presenting Unboxing AI: Check out CARPL’s video series, Unboxing AI, featuring experts discussing AI and its future in radiology. The next episode on August 2 features Larry Sitka of PaxeraHealth – reserve your seat today.
- Missed Appointments and Last-Minute Cancellations Can Add Up: Every missed appointment can cost providers an average of $200. PocketHealth’s new Appointment Reminders service can decrease no-show rates by up to 30%. Find out how in this article.
- A Step-by-Step Approach to Radiology AI Adoption: Widespread adoption of radiology AI has the potential to revolutionize patient care, but the path to success requires a systematic approach. Blackford offers a step-by-step guide for healthcare providers looking to get started.
- The Benefits of an AI Accelerator: What is an AI accelerator, and how can it impact your practice? Learn about the Visage AI Accelerator program and its impact on research and clinical practice in this video from Visage Imaging.
- Revolutionizing Radiology with Clear Visual Intelligence: The University of New Mexico Hospital is partnering with Riverain Technologies to revolutionize radiology with the use of ClearRead CT with Clear Visual Intelligence for chest CT scans. Get details about the partnership on this page.
- Calling on All Partners: We Want to Work with You: Merge continues its legacy of building strategic partnerships as part of Merative. Investing purposefully, we are building business relationships that meet healthcare client needs to improve patient care. Contact us today.
- Next-Generation Radiology Reporting: Join the conversation in this webinar recording and hear from PACS administrator Griff R. Van Dusen of Memorial Health System how Nuance PowerScribe One’s next-generation reporting experience helps streamline workflow and improve report quality so radiologists can get more done in less time.
- Celebrating Happy Customers: There’s nothing better than happy customers. Find out what radiology personnel at Western New York MRI in Buffalo had to say about their new uMR 680 scanner from United Imaging.
- Seamless Integration and Efficient Reading: TeraRecon’s latest Intuition advanced visualization solution now features seamless integration with Mirada Medical’s Mirada XD, providing efficient diagnostic reading with automatic multi-modality and multi-time point registration capabilities. Schedule a demo to learn more.
- Solutions to Transform Medical Image Delivery: Medical providers and health systems are looking to ditch the disc and modernize their patients’ journey. Learn how Clearpath helps them reduce the cost of retrieving and fulfilling patient requests for imaging and medical records.
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