Will Artificial Intelligence and Machine Learning disrupt radiology similar to Kodiak Robotics (California based startup) a company which has pioneered autonomous/self-driving trucks and plans to disrupt the commercial long-haul trucking industry? It has started operations in Texas and is making its first commercial deliveries from Dallas to Houston with a safety driver behind the wheel. The self-driving trucks will have a human safety driver behind the wheel to ensure safe operations.
Does radiology face a similar future were Radiologists will become safety doctors in a world that machines will read and report the diagnostic studies? Recent article in JACR titled, “Artificial Intelligence May Cause a Significant Disruption to the Radiology Workforce” addresses some of the ongoing controversies on what and how AI can change our future.
A Stanford University group developed a machine learning algorithm that can detect pneumonia from Chest X-rays at a level exceeding practicing radiologists. The algorithm is called CheXNet, the machine learning algorithm used the largest publicly available chest X-ray dataset released by NIH containing 112,120 frontal view X-ray images of 30,805 unique patients. Additionally, Computer Vision & Artificial Intelligence, Department of Computer Science, Technical University of Munich, Germany has developed automated algorithms that will diagnose Tuberculosis in Chest Xrays as an effective method to make widespread tuberculosis screening a reality.
Hopefully, AI will not replace Radiologists/doctors in the near future. Instead, it can assist doctors in decision making and improve efficiency in interpretation.
I came across an interesting quote which makes physiologic correlation with mindfulness. “The way you breathe is the way you think. The way you think is the way you breathe.”
FRS President’s Message As we tip-toe through hurricane season here in the state of Florida, having just avoided at least one catastrophic storm, we are becoming increasingly mindful of a different kind of developing storm in healthcare. This crisis, pulmonary illness related to E-cigarette use, is of national interest and I would like to take a moment to bring it to our attention. In our practice we have already prospectively seen several cases and retrospectively I am told nearly a dozen cases. As health care providers, I feel that it is important to take on this crisis and as radiologists we need to become familiar with the imaging findings as our knowledge base of this disease develops. For this reason, we will be adding a special lecture to the FRS summer meeting on this topic. Please stay in tune next month for more details on how we can help identify these cases in the state of Florida. Meanwhile, be mindful of the rising incidence of this entity in your clinical practice. Attached are some useful links for more updated information:
Overall, the past month has been one of planning for the FRS, most notably planning the 2020 annual meeting. In addition to having a dedicated presentation on vaping lung, plans are developing to add a job fair to the meeting. The planning committee has decided that a Sunday job fair would best suit the prospective job applicants and representatives, so this will be in the works as an exciting new addition for the FRS meeting in 2020. Thanks to all who are making this happen with lots of focused work being done currently in the background. We will be offering more information soon regarding the planned summer annual meeting.
In addition to this, we are pleased to begin offering exposure to available job information in the FRS E-brief with dedicated space for job advertisement for those interested. Our goal is to offer a platform that serves as a mutual benefit to those seeking employment and those offering opportunities in our growing radiologic community in the state of Florida. Please contact me or the FRS office with any input that you feel should be expressed in regards to the development and implantation of this platform.
Thank you for engaging in the FRS and growing with us!
The Radiology Business Management Association (RBMA) introduced a new format for the 2019 Learn Conference by blending pre-conference webinars focusing on the major business issues facing radiology, high level briefings in Washington DC, and a “Hill Day” where conference attendees visited with over 50 Congressional offices on Capitol Hill. The pre-conference webinars addressed three major issues attendees would be speaking with members of Congress and Congressional staffers about, specifically Surprise Billing Legislation, Date of Service (DOS) Reporting, and the Center for Medicare and Medicaid Services’ (CMS) changes to Evaluation and Management (E & M) payments under the proposed 2020 Medicare Physician Fee Schedule (MPFS).
Surprise Billing Proposed Legislation The No Surprises Act, co-authored by Energy and Commerce Committee leaders Rep. Frank Pallone (D-NJ) and Rep. Greg Walden (R-OR would prohibit balance-billing patients and establish commercial health plan payments based on each health plan’s median in-network rates. Initially, the No Surprises Act did not include an Individual Dispute Resolution (IDR) process for providers and payers to challenge the median reimbursement. However, on July 17th, the Committee passed the No Surprises Act with the addition of an arbitration process for resolving some out-of-network payment disputes.
The Senate has also introduced two surprise-billing Acts, the Lower Health Care Costs Act, introduced by Sen. Lamar Alexander (R-TN) and Sen. Patty Murray (D-WA) and the STOP Surprise Medical Bills Act, introduced by Sen. Maggie Hassan (D-NH), Sen. Bill Cassidy (R-LA), and a bipartisan group of senators. Like the House version, the Lower Health Care Costs Act would require health plans to pay providers the local, median in-network contracted amount. And also like the House, the STOP Surprise Medical Bills Act includes an IDR process for out-of-network payment conflicts between providers and payers.
Concerns set forth by RBMA Members during “Hill Day” included a) the potential for rate-setting to impede a fair in-network negotiation between radiology groups and payers, b) the median payment does not consider site acuity, c) a threshold of $1,250 for initiating an IDR process disadvantages radiology, since, according to an RBMA survey, 80 percent of patient bills are less than $200, and d) the requirement that patient statements be received within 45 days from the date of service does not allow time for payer adjudication, most notably in a hospital-setting.
DOS Reporting The RBMA has been struggling with CMS over the date of service for professional interpretations for over a decade and this issue has been further complicated by the issuance of conflicting guidance by Medicare carriers. Current CMS guidelines state the date of service for the professional component is the date the interpretation was rendered. However, according to a March 2019 RBMA survey, 89 percent of respondents are reporting the technical service date as the date of service for the professional component. To complicate matters further, a majority of commercial payers use the date the image is captured as the DOS for the professional interpretation. The “ask” from RBMA members during “Hill Day” was for CMS to give radiologists the option of reporting either the date the technical exam was performed or the date the professional interpretation was rendered as the DOS for the professional interpretation. Congressional members and staffers were asked to send letters or make calls to CMS in support of this position.
Changes to Evaluation and Management Payments under the Proposed 2020 Medicare Physician Fee Schedule CMS has proposed that all five levels of E & M CPT® codes be paid separately for established patients and a four-tier coding system for new patients, as opposed to blending rates for certain levels, which was finalized in the 2019 MPFS Final Rule. CMS is also proposing to adopt the AMA’s CPT® Editorial Panel’s revised E & M code definitions beginning Jan. 1, 2021. These code changes would revise the time and decision-making guidelines for each level and would require documentation of patient history and a medical exam only when clinically appropriate. Providers would be allowed to choose visit levels based on the extent of decision-making in the exam or based on time spent with the patient.
CMS has also proposed adopting the AMA’s RUC-recommended payment rates, which are based on a survey of 50+ specialty types. The survey shows office/outpatient E & M visits are typically more complex and require additional resources. This change means CMS would not blend code levels 2 through 4 but would make payments based on each level of service.
An estimated $5 billion dollars will be needed from other specialties to satisfy these proposed changes to remain budget neutral and the impact to radiology would be an approximate eight percent decrease in payments. Congressional members and staffers were urged to limit the negative impact on specialties such as radiology and to reconsider budget neutrality during “Hill Day.”
The week of September 16th was the first week of House and Senate Committee meetings before the upcoming January legislative session.
Speaker designee Chris Sprowls was officially designated by the House Republican caucus.
The meetings this week were fairly quiet. Amy Baker, Florida’s Chief Economist presented a tight budget forecast in both her House and Senate presentation, predicting a $867 million short fall in revenues coming into the state coffers. The main topics were gun safety, mental health issues, the Secretary of Health presenting to the Senate and House committees on the Hepatitis outbreak, and the opioid issue. There was a brief presentation by the Department of Health on implementation of Telehealth before the House Health Quality Committee.
The House and Senate will be holding their next set of committee meetings the week of October 14th-18th and October 21st-25th. The week of October 21st-25th will also be a Special Session. Senate President Galvano called a special session in response to the Special Masters report on Broward County Sheriff Israel. The Legislature is to vote on the Special Masters report to reconsider Sheriff Israel’s suspension and reinstate him as Sheriff of Broward County. Due to them being in Special Session that week, there will be no fundraiser’s for sitting members.
Please feel free to contact me with any questions.
Attention FRBMA Members! Please support the cause. We encourage you to be PAC members and supporters; you do not have to belong to the FRS. Donations can be made online through our PAC website www.FLRADPAC.org.
We would like to recognize the following contributor(s) to the FRS PAC in September: Dr. Sharma
It is critical that we support both our Florida PAC and RADPAC in order to bolster our voice in Tallahassee and Washington, respectively. Please join FRS lobbyist Alison Dudley in her special appeal for all Florida radiologists to become Florida PAC members. If you would like to help FRS defend radiology against untoward legislation and introduce bills that have a positive impact on our practices, we need your financial support to re-elect our friends in the state House and Senate. The FRS can also show you simplified ways on how to sign up your radiology group. Contact Lorraine Roger at email@example.com or contact Alison Dudley at firstname.lastname@example.org for more information.
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