The top 10 trends and takeaways from RSNA 2016
December 07, 2016
By the HCB News editorial team
That spike and sudden decline in steps-per-day on your smartphone pedometer can only mean one thing: RSNA 2016 is officially in the books.
Last week, McCormick Place in Chicago was buzzing with health care professionals trying to get a sense of how radiology will look in 2017 — and many of them are still trying to process the deluge of information they ingested.
Whether your head continues to spin, you missed the show entirely, or you just want to compare notes... here is the HealthCare Business News list of top 10 trends and takeaways from RSNA 2016:
Affordable is in
In the past, RSNA has as times felt like a car show for medical equipment; a showroom full of incredible machines that will probably not appear in your neighborhood any time soon. This year, there was a noticeable shift toward practical cost-saving innovations that might appeal to non-academic facilities.
With MAGNETOM Sempra, Siemens touted a relatively low-cost MR solution as its "most cost-effective" 1.5 Tesla scanner. The system is designed to be a workhorse for facilities that aren't looking for lots of bells and whistles, but also cannot risk the downtime that may come with inferior systems.
Hitachi unveiled the Supria 16-slice CT scanner at last year's RSNA and began delivering units to hospitals at the beginning of this year. The XR-29-compliant system has led to a resurgence in 16-slice scanners, according to Mark Silverman, Hitachi’s director of CT marketing.
Even Toshiba's new Vantage Galan 3T is intended to bring the benefits of higher magnet strength to a more everyday setting. “3T has often been limited to research settings and the capabilities of the Vantage Galan 3T open up a new world of possibilities for routine and advanced MR," said Dominic Smith, senior director, CT, PET/CT, and MR for Toshiba. "The system dramatically simplifies complex MR exams and offers patients a quiet and comfortable experience, allowing health care providers to offer routine, high quality MR imaging to their patients.”
There's no hiding from MIPS
Next year's roll out of CMS' Merit-based Incentive Payment System has been a consistent source of anxiety for many radiologists. At RSNA, Dr. David Levin, Emeritus Professor and Chairman of the Department of Radiology at Thomas Jefferson University Hospital, likened the preparation process to that involved in a colonoscopy; you don't want to do it, but you should.
As part of MACRA, MIPS aims to bring the basic tenets of "quality over quantity" front and center to radiology, pushing practitioners to collect and interpret their own care delivery data if they want to avoid hits to reimbursement.
According to Pat Free, national vice president for radiology operations for McKesson, some radiologists are deterred from fully embracing MIPS preparation because they haven’t had experience with Physician Quality Reporting System (PQRS), or don’t have an administrative infrastructure to develop the program.
Advanced Data Systems (ADS) introduced its MACRA / MIPS EMR reporting capability for MedicsRIS at the show, and a free MIPS calculator from Innovacer is geared toward helping radiologists crunch their own numbers.
While preparing for MIPS is no picnic, there's no avoiding it — and the sooner it's done the less likely penalties will follow.
Age is just a number
Mammography screening was a red-hot topic at RSNA this year because of the final breast screening guidelines issued by USPSTF in January, which recommend that women between the ages of 50 and 75 with average risk for breast cancer should get mammograms every two years.
In a powerful and candid presentation, Dr. Michael N. Linver, adjunct professor of radiology at the University of New Mexico, made the case that the mortality rate associated with breast cancer for women in their 40s is much higher than the 15 percent reported by the USPSTF — and that even if it weren't, that percentage is still significant.
As for women over 75, findings presented by Dr. Cindy Lee, an assistant professor at the University of California, San Francisco, showed that “the continuing increase of cancer detection rate and positive predictive values in women between the ages of 75 and 90 does not provide evidence for age-based mammography cessation.”
Linver attributed the shortcomings in the USPSTF guidelines, in part, to the fact that there were no radiologists, surgeons or pathologists on the Task Force and that they were influenced by epidemiologists.
Other presentations also took aim at the USPSTF guidelines and highlighted flaws in its approach to quantifying risk. “Considering risk in ten-year age groups obscures important differences between large age-specific subgroups," Robert Smith, ACS vice president of screening, told another crowd of RSNA attendees.
Budget constraints have become all-too-familiar territory for hospitals and health care facilities, but OEMs are apparently getting the message, because more of them are offering multi-year service plans included in the price of new capital equipment.
For example, Siemens was touting the included two years of service, in addition to its standard one-year warranty, available on its new SOMATOM go. CT platform and its MAGNETOM Sempra 1.5 Tesla MR system (both are awaiting FDA clearance and were unveiled at the show).
Similarly, Hitachi is offering five years of total support on its 64/128-slice CT equipment. “We’re able to go into a community hospital and say this is more economical and you won’t have surprises,” said Mark Silverman, Hitachi’s director of CT marketing. “It won’t be that the X-ray tube burned out and you now have to spend $40,000 on something you weren’t expecting.”
These kinds of extended commitments between OEMs and providers echo the managed equipment service contracts we explored in our August magazine, where Altaf Stationwala, president and CEO of Ontario, Canada's Mackenzie Health discussed the benefits of his hospital's $300 million, 18-year MES contract with Philips. “We were less worried about the specific MR displayed at RSNA and more concerned about the longer-term partnership with a vendor that could help us equip the brand-new hospital,” said Stationwala.
Value-based care in the Trump era?
Within days of Donald Trump being elected the next U.S. President, (and just weeks before RSNA) Siemens announced its plans to make a public offering on its Healthineers business. In comments to the press, Siemens leadership acknowledged Trump's apparent commitment to infrastructure as a possible silver-lining of his upcoming presidency.
Still, most RSNA attendees and presenters couldn’t pinpoint exactly how a Trump administration will affect the health care industry in general, and radiology in particular — especially as the President-elect’s promise to repeal the Affordable Care Act and House Speaker Paul Ryan’s plan to privatize Medicare are still just ideas. But there was certainty that the health care landscape would change in meaningful way.
During a session on the transition to value-based imaging, moderator Dr. James Whitfill, chief medical officer at Scottsdale Health Partners, a physician-led clinical integration network and ACO in Arizona, said he saw a continued shift away from volume-based reimbursement.
“It doesn’t matter who is in office,” Whitfill told the audience at the Monday morning session. “We are going to see a relentless push toward new models of paying for health care, and that’s going to include value-based care. I’m not sure what our new presidency is going to bring, but I can guarantee you we’re going to continue to see a big push in this area.”
A singular digital storage solution
If MIPS and MACRA reimbursement concerns represented a central problem, enterprise imaging may be its solution — a way to reduce costs and establish sought-after quality metrics to keep radiologists afloat and informed in changing times.
"Enterprise imaging is a program for bringing together all medical images from across an enterprise," Dr. Cheryl Petersilge of Cleveland Clinic, said in a session. "We have to think beyond medical imaging as just being DICOM images that are generated within the radiology department."
Carestream unveiled its Unified Core architecture for its Clinical Collaboration Platform at the meeting. In describing the management and archiving solution, Ludovic d’Aprea, Carestream’s Global GM for Healthcare Information Solutions said, “Users can add modules on an a la carte basis to a scalable infrastructure instead of installing and supporting separate viewers or archives for activities involved in the management of images and related patient clinical data.”
A range of other enterprise imaging solutions were showcased by companies like Agfa Healthcare, INFINITT, Visage and ProMedica.
Finding our way with 3-D printing
A Sunday session at RSNA entitled "Principles and Practice of 3-D Printing" laid a groundwork for the type of innovations being developed with the aid of 3-D printing. Dr. Jonathan M. Morris of Mayo Clinic and Dr. Frank Rybicki of the University of Ottawa discussed their firsthand clinical experiences with the technology.
While spine applications like scoliosis first emerged as promising for 3-D printing, eventually every surgical specialty at Mayo Clinic asked for a 3-D printed model of patients' anatomy to help them plan for procedures.
According to Morris, 3-D anatomic models are generating significant cost savings in the operating room where an external pelvectomy procedure can cost $275,000, but a $700 3-D model can drastically reduce operating time and improve outcomes.
Research presented at RSNA also showed how 3-D-printed fetus reconstructions based on images derived from ultrasound and MR can help physicians verify the health of an unborn child, assess its airways or help parents understand treatment decisions.
The practice may still be in its infancy, but — this year more than ever — RSNA showed that 3-D printed anatomical patient replicas are poised to fit into personalized medicine and improve how physicians assess the body.
MR and the limits of technology
Whether it was GE unveiling Freelium, a magnet technology designed to use one percent of liquid helium compared to conventional MR magnets, or Compressed Imaging from Siemens, which allows MR scans to be performed in a fraction of the time — MR appeared to be the primary imaging modality enjoying the most innovation at RSNA.
And yet, for all the progress taking place, patient safety is still a big problem in the MR environment. There has been an almost 500 percent increase in MR adverse events from 2000 to 2009 in the face of only a 114 percent increase in volume growth, according to a presentation by Armen Kocharian, Ph.D., senior imaging physicist, Houston Methodist Hospital, and he suspects those statistics are low.
The paradox of adverse incidents to jaw-dropping innovations illustrates a uniquely RSNA 2016 point: the greatest imaging equipment and the greatest software in the world are useless (at best) and dangerous (at worst) when they are not being overseen by capable radiologists. If that wasn't true enough already, it will be increasingly true under MACRA and the new radiology reimbursement system.
Radiologists are people too
Yet another theme tied in with MACRA and value-based care was the growing demand for radiologists to interface with patients. Whether it be a push to enhance social media presenceor being more cognizant of the mood their waiting room TV channel may be creating, radiologists are being pulled out of their quiet comfort zones.
A University of Michigan study surveyed 1,976 radiology patients regarding their perceptions of radiology and radiology results. The researchers showed that many patients hoped for more face time with a radiologist to gain a better understanding of their results.
On the other end, radiologists must also get friendly with referring physicians, who may present negative feedback if their patient cannot get a study scheduled in time, the report is not available in a timely fashion, or if the physician isn’t notified about changes in reports.
As software takes over a lot of the traditional time-suck responsibilities of radiologists, it will become increasingly important for them to act as engaging and articulate liaisons between imaging exams, patients and a care team that extends beyond their facility.
Beyond imaging lies informatics
For years, the question "how can we make this data sing?" has summarized a software conundrum: a billion terabytes of information are useless without a system to organize it.
At RSNA we saw convincing indications that data is truly finding its voice, and in some cases it sounds a lot like artificial intelligence. Perhaps more than any other exhibitors, Merge and IBM Watson showed attendees that when big data is combined with machine learning, some exciting new doors open up. But a handful of other companies, including Sectra and Novarad unveiled their own application platforms driven by artificial intelligence.
Through its partnership with Zebra, Carestream showed it can incorporate artificial intelligence protocols into its Unified Core architecture, and — based on a patient’s bone structure and calcification — determine if they’re at risk for osteoporosis.
The major imaging OEMs also showed off huge strides into cognitive technology. Whether it was Philips with Illumeo or GE Healthcare with the Integrated Relevant Clinical Content (IRCC) development for its Universal Viewer, a recurring message was that smart software can work wonders to bring relevant information to the surface and take some of the tediousness out of image interpretation.