“Implementation of effective measures to eliminate waste represents an opportunity to reduce the continued increases in US health care expenditures.”
The big takeaway from a JAMA study estimating that 25% of U.S. healthcare spending is due to waste. Not the flashiest quote, but an important one.
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 genuine AI technology to disrupt the industry
- Qure.ai – Making healthcare more accessible by applying deep learning to radiology imaging
The Imaging Wire
A New JAMA study caught the attention of the healthcare community this week, singling out administrative complexity as the largest source of wasteful health spending, while estimating that healthcare waste costs $760 billion to $935 billion annually (25% of overall costs). The good news is, if a series of already-identified interventions are adopted nationwide (that’s a big if) this waste number could be reduced by between $191 billion and $282 billion. Here are some details on the six key waste domains and how they can be improved:
Administrative Complexity – With $265.6 billion in estimated annual costs, administrative complexity was responsible for the most waste. However, unlike the other waste domains, the researchers could not find any reports on efforts to reduce complexity-related waste.
Pricing Failure – With the second highest costs of between $230.7 billion and $240.5 billion, pricing failure waste could be reduced by between $81.4 billion and $91.2 billion by adopting drug pricing and payer-focused interventions as well as new transparency strategies.
Failure of Care Delivery – Care delivery failures such as hospital-acquired conditions and clinician-related inefficiencies are responsible for $102.4 billion to $165.7 billion in waste, while interventions could reduce care delivery waste by between $44.4 billion and $93.3 billion.
Overtreatment or Low-Value Care – The use of low-value medication; low-value screening/testing, and overuse of end-of-life care drive between $75.7 and $101.2 billion in waste, which could be cut by $12.8 to $28.6 billion if interventions were pushed nationwide.
Failure of Care Coordination – Unnecessary admissions and avoidable complications / readmissions are responsible for between $27.2 billion and $78.2 billion in waste, while efforts to improve care coordination could reduce this waste by $29.6 billion to $38.2 billion.
Fraud and Abuse – Just looking at the Medicare population, fraud and abuse are responsible for $58.5 billion to $83.9 billion in waste, while government interventions could reduce this waste by $22.8 billion to $30.8 billion.
A new imaging technique using small steel magnetic markers, called Magseeds, could be used with a magnetic handheld probe to localize impalpable breast lesions and detect sentinel lymph nodes. Here are some details:
Magseeds – The small steel markers are placed in breasts with ultrasonographic or mammographic guidance and lesions are detected through SPIO particles using a magnetic handheld probe.
The Study – A team of Slovakian researchers placed localization seeds in 38 patients with breast tumors (27 malignant). The Magseed method accurately localized tumors in all 38 patients, leading to successful SLN biopsies in all 27 patients, and the removal of all tumors with tumor-free surgical margins.
WGL Alternative – Wire-guided localization (WGL) is the current standard to guide the removal of impalpable breast lesions, although WGL comes with a list of potential complications (wire migration, wire transection, patient discomfort, and pneumothorax) and requires the support of a nuclear medicine department.
Closing the Loop
A recent Healthcare Administrative Partners (HAP) blog post detailed how radiology practices can ensure that they have the proper patient tracking and follow up practices in place, recommending that:
- Practices design their processes based on their tracking software (terminology, structure) to ensure compatibility.
- Imaging providers collect patients’ PCP details through multiple methods so they can communicate to patients with/through PCPs.
- Avoid false follow ups, such as a patient with chest CT follow up marked as “complete” due to an unrelated emergency department CT scan.
- Most importantly, HAP suggests layering solutions to accurately identify and track incidental findings and follow-up recommendations, including using both radiologists and AI, using NLP systems to identify follow-ups, providing radiologists with multiple templates, keeping speech files updated, and using analytics to find data anomalies.
Nominations Open for First Annual Imaging Wire Awards
Nominations are open for the first annual Imaging Wire Awards, honoring 2019’s most outstanding contributors to radiology practice and outcomes.
The Imaging Wire Awards will be presented to five imaging professionals for achievements in the following categories:
- Insights to Action: recognizes efforts to reduce unnecessary imaging
- Diagnostic Humanitarian: for achievements supporting equality in patient care, in the U.S. or internationally
- AI Activator: recognizes actions to use artificial intelligence to improve patient care
- Burnout Fighter: for addressing inefficient work practices that lead to physician burnout
- Cornerstone: honoring non-physicians for outstanding contributions to the practice of radiology
Those interested in applying or nominating a colleague for one of the above Imaging Wire Awards can do so until November 8th using this link.
- A Chinese research team developed a new radiofrequency ultrasound method that combines with AI to differentiate malignant thyroid nodules and stratify risk levels more accurately than conventional ultrasound, potentially reducing unnecessary thyroid biopsies. Using a dataset of 131 ultrasound images (72 malignant), the radiofrequency ultrasound-based algorithm predicted malignancy with greater sensitivity (100% vs. 94.4%), accuracy (96.2% vs. 93.9%), and AUC (0.945 vs. 0.917), but slightly lower specificity (91.5% vs. 93.2%) versus a conventional ultrasound-based algorithm.
- Canon Medical Systems launched its Alphenix Encore Plus Program, which allows current Canon customers to upgrade their older Infinix-i angiography systems with new technology (e.g. improved image quality, larger monitors, and cybersecurity), while maintaining many existing parts (e.g. lights and shields) and reducing the costs and disruption associated with upgrades. Canon/Toshiba has maintained the ENCORE upgrade program for years, also covering its MR and ultrasound lines.
- A paper from an Atlanta area team of radiologists identified ways to expand radiologists’ role in decision making (SDM). The paper suggested that radiologists can play a role in the following SDM areas: 1. Patient access to information (promoting creation and awareness of patent portals); 2. Patient understanding of information (creating easier-to-understand reports); 3. Patient appraisal of findings (adding patient messages to reports or using telemedicine to explain findings); 4. Applying knowledge in care decisions (use patient decision aids to communicate benefits and risks of tests and treatments).
- SuperSonic Imagine had a busy week, introducing its new Aixplorer MACH 20 ultrasound system, a new lineup of ultrasound markers for liver detection, and making its new Needle PL.U.S. imaging needle visualization mode available with its Aixplorer MACH 30 system. The Aixplorer MACH 20 appears to be a scaled-down counterpart to the 1.5yr-old Aixplorer MACH 30, while still leading with SuperSonic’s ShearWave PLUS elastography technology.
- A new study published in the Journal of Nuclear Medicine suggested that standardizing preclinical PET/CT imaging protocols will help make preclinical datasets more reproducible / consistent, supporting the translation of studies to the clinic. The team reviewed five different commercial preclinical PET/CT scanners in Europe and the U.S. using seven different phantoms, finding numerous discrepancies and making a range of standardization suggestions to address them.
- NPR’s All Things Considered covered a new smartphone app that can detect early signs of the eye disease, leukocoria, by scanning babies’ pupils in smartphone photographs to find white eye. The CRADLE app was developed by the father of a child who eventually lost an eye to leukocoria with the goal of helping other parents seek diagnosis for possible eye diseases earlier. This isn’t our type of imaging, but it’s a reminder of the power of an inspired parent and how consumer technology is increasingly allowing home diagnoses.
- GE Healthcare continued its PET tracer partnership spree, announcing an alliance with Theragnostics to develop and launch the company’s GalliProst PSMA PET imaging agent (Theragnostics will focus on development, GE will focus on commercial and distribution activities). This is GE’s third PET tracer partnership in the last month, following similar announcements with Affibody and AdAlta.
- Point-of-Care Ultrasound and MRI were named among the ECRI Institute’s top-10 health technology hazards for 2020. POCUS came in as the second greatest hazard, due to ECRI’s belief that its adoption is outpacing training/experience-based safeguards. The risk of missing medical implant data delaying MRI scans or making them more dangerous, earned the modality the ninth spot.
- A Chinese study came out in support of the contrast-enhanced ultrasound liver imaging reporting and data system (CEUS LI-RADS), finding strong interreader agreement for the various CEUS LI-RADS categories and calling it a promising way to categorize high-risk patients. The retrospective study of 1,366 patients at risk for hepatocellular carcinoma (HCC), who underwent CEUS, had four ultrasound physicians rate the likelihood of focal liver lesions (FLLs), finding strong interreader agreement for CEUS LI-RADS categories (0.61 to 0.73), APHE (0.65 to 0.83), and washout appearance (0.58 to 0.71).
- Change Healthcare announced that its CareSelect Imaging decision support solution now uses AI technology to improve CDS consultation workflow and streamline the decision-making process. Although the announcement mainly emphasized the use of AI technology, CareSelect Imaging’s AI site reveals that the new algorithms will leverage historical and future data to help guide the CDS process, such as supporting the selection of imaging indications.
The Resource Wire
- In this interview, Nuance Chief Medical Officer, Woojin Kim, MD, discusses the evolving role of blockchain in healthcare.
- Qure.ai got solution-oriented in its latest blog, analyzing how acquisition artifacts are responsible for AI performance degradation, and introducing two methods to solve this problem.
- Carestream Health received India’s “Most Trusted Healthcare Brand” Award, based on a review of its growth, reach, Infrastructure, innovation and other key metrics.
- 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 2019 State of the Field Report is now available, detailing FUSF’s initiatives and achievements and the state of the focused ultrasound market.
- POCUS Systems’ forthcoming ultrasounds will combine ease of use, durability, and reliability, allowing clinicians to focus on their patients.