Corporatization & Unionization | US CPT Code Reversal

“Ironically, the courts will keep both AI and radiologists tethered to each other, granting neither complete autonomy.”

UPenn’s Saurabh Jha on how the threat of malpractice will ensure that AI won’t be used without radiologist oversight and radiologists won’t practice without AI support.


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The Imaging Wire

Corporatization & Unionization

The JACR put corporate radiology groups in the hot seat this week with a pair of papers detailing how young radiologists are concerned about corporatization and should consider unionizing to protect themselves.

  • ECRs’ Corporate Fear – Early-career radiologists (ECRs) are concerned about corporatization’s potential impact on their careers. That’s from a new JACR study that surveyed 602 ECRs and found that 85% were aware of national corporatization, 86% believe corporate entities harm radiology (yes, 1 point higher), 83% prefer to join independent private practices, and 72% worry about their practices being acquired.
  • Rad Unionization – A UCLA professor and neuroradiologist quickly shared a solution for these concerned ECRs: unionize. Arvind Vijayasarathi, MD’s opinion piece suggested that creating a radiologist union would help represent rads in collective bargaining negotiations with national practices, while reminding radiologists that many of their associates are already in unions (nurses, rad techs, etc.). Vijayasarathi admitted that there are plenty of obstacles in the path towards creating a radiologist union (political, social, international telerad alternatives), but maintained that its worth considering.



US CPT Code Reversal

Podiatrists were racking up some impressive extremity nonvascular ultrasound (aka MSK ultrasound) usage growth between 1994 and 2010, but that changed quickly when a new US CPT code was introduced. A new Harvey L. Neiman Health Policy Institute study detailed the numbers behind MSK ultrasound’s utilization turnaround and what that may mean for managing utilization going forward.

  • Podiatrists’ Growth – Back when there was a single CPT code (1994-2010) podiatrists’ MSK ultrasound utilization grew at an 87.1% annual rate (vs. rad’s +6.1% rate). This growth brought podiatrists’ utilization share up from 9% in 2001 to a 31.3% peak in 2009.
  • Policy Change – Growth like this caught the CPT’s attention, leading them to separate the single MSK US code into separate “comprehensive” and “focused” examination codes with differential reimbursement.
  • MSK US Correction – That code change caused podiatrists’ annual utilization growth to plummet to +0.4% for comprehensive exams and +0.6% for focused exams (vs. rads’ +2.7% & +12.3%) from 2011 to 2017, while their overall share of MSK US exams to fell to 14.3% in 2017 (vs. rads’ 40.4%).
  • Takeaway – 2011’s MSK US reversal is a solid example of how code changes lead to utilization changes – and this one also reduced healthcare costs and drove more MSK US volume to radiologists. Although the study calls for more research, it also suggests that moves like this could drive other utilization changes going forward.

The Wire

  • Who’ll Get Sued for AI Malpractice? A recent statnews.com editorial from UPenn’s Saurabh Jha, MD explored how malpractice lawsuits might work as healthcare AI expands, suggesting that providers, hospitals, and AI firms all could eventually find themselves as defendants. However, Jha was even more sure that the threat of lawsuits will keep AI and radiologists “tethered to each other,” as legal concerns would keep hospitals from adopting AI without human review and make radiologists think twice before overruling an AI interpretation without ordering further exams.
  • Transpara 2D & 3D: ScreenPoint Medical announced the FDA approval and U.S. launch of Transpara 1.6.0, making it the country’s first breast AI solution for both 2D and 3D mammography. The launch makes Transpara 3D available to ScreenPoint’s U.S. customers, who had access to Transpara 2D (2D + 3D was already available in Europe).
  • New Cancer Agent: A Washington University team developed a new octapeptide-based imaging agent labeled with a near-infrared dye that could help doctors identify multiple types of tumors and illuminate the normal surrounding cells that cancer takes over as it spreads. The new investigational agent (called LS301) is being tested in small clinical trials, starting with evaluations for breast cancer imaging and potentially expanding to guiding cancer treatment.
  • COVID-19: This was originally a story about how bad it’s gotten in Italy (more on that here), but the coronavirus news cycle moves fast and COVID-19 is officially more than an Italy/Iran/China problem now. At this point most readers know that it’s spreading and how to be responsible from a clinical and public health perspective. We’ll keep covering coronavirus-related radiology news in upcoming issues – everyone take care till then.
  • Microwave + MR Imaging: A Dartmouth team landed a $3m NIH grant to develop a new microwave + MRI breast imaging technique that they say could produce “substantially clearer imaging,” reduce unnecessary breast biopsies, and eliminate contrast. The new platform is the first to combine Microwave and MRI imaging (sMMRI), addressing MRI’s specificity challenges and microwave imaging’s poor resolution, while continuing microwave imaging’s recent research momentum.
  • Nuance & AMA Collaborate: Nuance and the American Medical Association announced plans to pilot new approaches to reduce documentation burdens that can undermine patient care and lead to burnout. The pilot solutions will leverage Nuance’s ambient clinical intelligence (ACI) along with AMA’s expertise in physician burnout prevention and healthcare informatics (particularly IHMI’s clinical knowledge graph) with the goal of streamlining how clinical information makes it into EHR systems.
  • DBT’s Five-Peat: A UPenn team reviewed five years of DBT screenings / outcomes and one year of mammography screenings/outcome (n = 56,839 DBT exams, 10,511 DM exams, 29,310 women), finding that DBT beat DM in nearly every key area. DBT achieved lower recall rates (8.0% vs 10.4%), higher cancer detection rates (6 per 1k, vs. 5.1 per 1k), greater detection of invasive cancers (70.0% vs 68.5%), and higher detection of cancers with a poor prognosis (32.6% vs 25.0%). Critics may say we’re still working our way towards DBT proving its effectiveness over the long term, but these results are pretty compelling.
  • End of Support: Wired.com revealed that “83% of medical imaging devices run on operating systems that are so old they no longer receive any software updates at all.” That’s up 56% from 2018 and it’s largely due to Microsoft ending support for Windows 7 in January. Although this doesn’t mean that 83% of imaging devices are in immediate danger of being hacked (especially if they are firewall protected and monitored), the fact that they won’t get patches going forward means that devices in less-guarded networks will be vulnerable.
  • CT Dosage & DNA: New research out of Japan found that low-dose CT does not have a detectable effect on human DNA, but standard-dose CT does. The researchers reviewed blood samples from 107 people who underwent low-dose chest CTs and 102 people who underwent standard-dose chest CTs, finding that the number of double-strand breaks (p < 0.001) and chromosome aberrations (p = 0.003) increased by statistically significant levels. Next, the team will research other modalities’ effect on DNA.
  • PET Growth: A report from IMV Medical Information Division detailed on AuntMinnie.com found that U.S. PET scan procedure volume grew at a 6% annual rate since 2013 and reached a record ~2,200,800 scans in 2019. IMV attributed this trend to the rapid adoption of PET/CT scanners, the development of new tracers, and expansion into cardiology, while forecasting that PET’s growth will continue in 2020 (+6% to 7%).
  • Digital Variance Angio: Kinepict Health announced the FDA 510(k) approval of its Kinepict Medical Imaging Tool (KMIT) imaging software. The software uses Kinepict’s digital variance angiography (DVA) technology to support the visualization of blood vessels by identifying contrast-induced changes in an X-ray angiography image series. The software can reduce dosage by as much as 70% and could also make angiography safer and more powerful.
  • Insightec Adds $150m: Insightec announced a $150m Series F round led by Koch Disruptive Technologies (KDT), valuing the MR-guided focused ultrasound company at a whopping $1.3 billion. KDT committed $100m for this round, which is its second round with Insightec.

The Resource Wire

– This is sponsored content.

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  • Riverain Technologies is dedicated to providing enterprise software tools to aid clinicians in the efficient, effective, early detection of lung disease.
  • Healthcare Administrative Partners understands the issues facing your radiology practice. Visit HAP Booth #406 at RBMA PaRADigm to pick up a flash drive with educational videos discussing 2020 MPFS updates, surprise billing, and physician recruitment.
  • In its latest Q&A, Nuance sat down with HealthLytix to understand the company’s journey and reveal its vision for how AI/ML-based solutions will improve the speed/accuracy of MR and CT imaging and reporting.
  • This Nature Research study found that Qure.ai’s qXR tool can identify TB-associated abnormalities in chest radiographs with over 95% accuracy, potentially eliminating 2 out of 3 Xpert MTB/RIF tests.

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