Surprise Billing Battle Continues | Probo Grows

“When AI > AI+human, we face important ethical questions.”

Alexandre Cadrin-Chênevert in response to Lunit’s big mammography AI study. The algorithm’s 0.940 AUC beat radiologists with AI support (0.881) and without it (0.810).


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The Imaging Wire

Surprise Billing Battle Continues

The battle over how to solve surprise billing is still raging in Congress, as a rare level of bipartisan collaboration (each side has bipartisan support) hasn’t been enough to overcome politicians’ industry loyalties (payers vs. providers). Last week brought two new proposals into the surprise billing battle, showing that congress is still working on a solution but isn’t quite there yet.

The Ways and Means Committee Proposal – Hospital lobbies and the ACR were pleased with the new Ways and Means Committee proposal, which would use mediation to settle surprise billing disputes.To providers, this is a welcomed alternative to using a benchmark rate that would give payers too much leverage. Unsurprisingly, payer groups pushed back on this new proposal.

The Education and Labor Committee Proposal – In an apparent effort to find a middle ground, the Education and Labor Committee proposed using a benchmark rate for care up to $750, while adopting an arbitration process for care that costs more than $750. However, it was met with opposition from payer groups and didn’t earn the approval from provider groups.

Specialists Targeted – Meanwhile, radiologists and other specialists are increasingly suffering collateral damage from the surprise billing battle. The biggest recent example of this is Envision Healthcare’s CEO’s decision to step down last week as congress investigates the 900-rad firm’s surprise billing practices. Meanwhile a new JAMA study just found that 20% elective surgeries might lead to a surprise bill and 22% of these surprise bills are due to the use of out-of-network radiologists (anesthesiologists led with 37%).



Probo Grows

Probo Medical announced its acquisitions of Elite Medical Technologies and Future Medical Equipment, expanding the traditionally US-focused company (both ultrasound and USA) to new modalities and countries.

  • Elite & Future – Elite Medical is a U.S.-based pre-owned imaging equipment reseller (CT, MRI, PET/CT), while UK-based Future Medical specializes in the de-installation, purchase, and sales of similar pre-owned modalities.
  • Probo M&A – Probo has been quite active over the last two years, levering its PE funding to merge with MedCorp in March 2018 and acquire Trisonics in February 2019 to become one of the largest independent ultrasound sales/service groups in the U.S.

These latest acquisitions bring a new diversification-focused angle to Probo Medical’s strategy, while still allowing it to take advantage of existing supply chains and relationships. It also continues the recent consolidation and diversification trend among independent imaging players.



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The Wire

  • A Georgia State and Emory study detailed how a new MRI contrast agent, called ProCA32.CXCR4, may allow earlier uveal melanoma cancer detection by targeting chemokine receptor 4 (CXCR4). The novel agent binds to CXCR4, which is elevated in patients with uveal melanoma cancer (typically liver, brain, and breast cancers), potentially allowing detection of uveal melanoma metastases before current contrast agents would be able to (as small as 1mm).
  • Large Colorado-based radiology practice, Radiology Imaging Associates (RIA, now 117 radiologists, 5 states), bolstered its Denver area presence with its acquisition of Rocky Mountain Radiologists (17 radiologists). In addition to bringing on Rocky Mountains’ team, the merger adds the firm’s contracts with SCL Health Denver to RIA’s customer base.
  • New research from a Mount Sinai radiology team found that the orthopedic clinicians they work with (n = 53 residents, attendings, and PAs) prefer a “middle ground” knee MRI reporting structure. The vast majority preferred a structured format with headers (83%), followed by “highly structured and itemized reporting templates” (11%), while only 6% preferred unstructured free text templates.
  • icometrix announced the FDA clearance of its new icobrain ep solution, which analyzes brain MRI scans and provides clinicians with quantitative reports to support the detection of epilepsy causes (e.g. measuring hippocampal asymmetry). The FDA clearance expands icometrix’s icobrain portfolio, which also includes AI-based solutions for the detection of MS, dementia, and TBI.
  • Wake Forest School of Medicine researchers scored a 5-year, $2.53 million grant from the NIH to research whether a novel PET brain imaging technique can identify early-stage Alzheimer’s disease. The researchers will use a new PET tracer to image microtubules (microscopic tubes that define the structure and movement of brain cells), exploring whether microtubule impairment can be identified long33 before it leads to cognitive decline (and therefore help predict/treat Alzheimer’s).
  • New research in AJR revealed that many radiologists and emergency medicine providers (EMs) still don’t trust images and radiology reports from outside their system. A survey (n = 34 radiologists and 38 EMs) found that only 32.4% of radiologists and 55.3% of EMs were confident in the quality of outside images, and their confidence levels were even worse regarding outside radiologists’ interpretations (20.6% of rads, 44.7% of EMs) and their ability to efficiently access these outside reports (23.5% of rads, 5.3% of EMs). It wasn’t all bad, as nearly all radiologists believe that outside imaging helps reduce repeat scans and 43.8% reported that it improves diagnostic confidence.
  • A team of Italian radiologists shared their opinions on who is responsible for imaging AI and how to ensure that AI is used ethically. The paper was quick to clarify that radiologists are responsible for their AI use, and therefore they should 1) be trained on using AI; 2) get involved in AI R&D; 3) be aware that black box algorithms create additional risks; 4) understand that their decisions may be biased by AI automation; 5) expect the lack of radiologists to drive demand for more AI tools; and 6) expect more need for informed consent and quality measures.
  • A new study from Australia detailed the high effectiveness of using radiographer‐led peripherally inserted central catheter insertion service (PICC) in an interventional radiology suite. A review of 366 consecutive PICC insertions by five trained angiography‐specialized radiographers revealed a 100% PICC insertion success rate, with 90% of PICC insertions requiring a single puncture and 9% requiring two punctures.
  • A study from The University of Texas at Dallas revealed progress towards potentially developing non gadolinium MRI contrast agents, by combining organic radical contrast agents (ORCAs) with a tobacco mosaic virus and encasing it within a chemical structure to help overcome ORCA’s historical drawbacks (weak contrast, quick reduction speeds). A study on mice found that this combination provided over two hours of contrast, roughly 20-times longer than previous ORCAs.
  • An MGH research team found that 3D micro-CT may be able to help ensure faster and more complete removal of breast cancer tissue during surgeries. The researchers imaged and analyzed 173 partial mastectomies, finding that Micro-CT often identify cancers in biopsy samples that are likely to be missed by pathologists (can spot cancers that are only on 0.45% of specimen vs. 1.55% for traditional pathology slides), while still identifying cancers that were identified by pathologists (93% of 114 cases). It also helps that there is already a CPT code for X-rays of biopsy samples.
  • MITA released new ultrasound remanufacturing guidelines, intended to help differentiate remanufacturing activities (FDA-regulated) from technical support activities (not regulated). Based on the MITA white paper, making the following technical changes may qualify ultrasound “service” activities as “remanufacturing” activities: control mechanism, operating principle, energy type, biocompatibility, design, and parts and module compatibility.

The Resource Wire

  • The GE Healthcare Venue Go features a uniquely adaptable design, a simple interface, and streamlined probe layout so you can go through your day quickly, efficiently, confidently.
  • What can your radiology practice do to improve patient satisfaction? This Healthcare Administrative Partners blog post outlines some steps to improve patient experience including issuing surveys and applying feedback, supporting a range of payment methods, and helping patients understand their coverage.
  • ClearRead Xray from Riverain Technologies includes the first FDA-cleared software solution to transform a chest x-ray into a soft-tissue image, providing unprecedented clarity for efficient, accurate, early detection of lung disease. Learn more.
  • Catch the Focused Ultrasound Foundation’s upcoming webinar (February 24, 1pm ET) about “Immunotherapy for Brain Tumors,” presented by Michael Lim, MD, Johns Hopkins’ Director of Brain Tumor Immunotherapy.

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