|How Tech Companies Are Using AI to Tackle Clinician Burnout, Administrative Burdens|
By Annie Burky | November 30, 2022
Burnout of healthcare professionals has not waned with the pandemic but assistance from artificial intelligence may offer tired workers a reprieve from tedious tasks and a chance to better connect with patients.
Half of physicians are experiencing burnout and 45% of physicians over 55 and 14% in the younger age group plan to stop seeing patients in the next three years, according to a survey from the Commonwealth Fund. Partially for this reason, primary care physicians and nurses are expected to leave the healthcare in droves in the upcoming years.
A survey by Incredible Health showed that that 34% of nurses planned on leaving the profession in 2022. Of those planning to leave, 44% cited high-stress conditions and burnout as the reasons for wanting to quit.
Once a clinician is hired, the tech is in place and a patient is ready to access care, the work AI can do to reduce burnout is only just starting, according to health tech company Botco.ai’s Co-Founder and Executive Chairman Anu Shukla.
AI-enabled triage can shuttle patients to the ideal care provider
By using Botco.ai’s automated intake process, patients get to the right provider faster without wasting time at the point of care communicating things like change of address and insurance provider. The platform reports that 89% of respondents claimed that the company’s automated chat tools make it easier for patients to access mental health treatment.
Of course, chat bots are already a common tool for communicating with patients, but Botco.ai is leveraging new technology that can be implemented in the highly sensitive behavioral health specialty.
“We’ve come across all these applications for sentiment analysis that had to judge how people are feeling and so that’s important in mental health applications,” Shukla told Fierce Healthcare. “We can recognize the words that lead to you putting up a message saying, if you are feeling you need immediate help, please call the suicide prevention health hotline.”
To read more, go to Fierce Healthcare.
Deductibles May Prevent Women From Seeking Follow-up Breast Cancer Screenings
By Jessica Kania | November 29, 2022
Women will often skip recommended follow-up tests after abnormal findings on a mammogram if they have to pay a deductible for those tests, according to new research presented at RSNA 2022.
The observation is based on a survey of 932 patients presenting for breast imaging at Boston Medical Center. More than one in five respondents (21.2%) said that they would skip indicated follow-up imaging if they had to pay a deductible, and an additional 19.5% said that they weren’t sure whether they would go for additional imaging. Just 59.4% of respondents said they would not skip recommended follow-up imaging even if they had to pay for it.
The study covers a gap in previous research about what patients would be willing to pay for, noted lead author Michael Ngo, MD, a radiology resident at Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine.
“Prior studies have shown that out-of-pocket costs deter patients from attending screening mammography,” Ngo said in an RSNA-provided statement. “Other studies found that screening rates go down when there is an out-of-pocket cost for follow-up imaging after an abnormal finding on screening mammography. However, there is a lack of research into patient adherence to the recommended follow-up imaging when there is a deductible. Our research aims to address this paucity.”
The data is especially relevant due to current coverage conditions under the Affordable Care Act, which dictates that most plans are required to fully cover initial screening mammograms—but not additional screening services—with no out-of-pocket costs for patients.
“If the radiologist detects an abnormal finding on the screening image, then additional images and a biopsy are needed to determine if the patient has cancer. The ACA does not mandate insurance to cover the costs of these additional services,” Ngo explained.
High-deductible health plans (HDHPs)—which typically offer lower monthly insurance premiums, but require patients to pay higher deductibles—mean that out-of-pocket deductible costs can exceed $1,400 for singles and $2,800 for families, with Ngo noting that this may cause people to refrain from seeking necessary care.
Ngo also noted disparities in answers based on race and socioeconomic status, with respondents most likely to skip care identifying as Hispanic (33%), having a high school education or less (31.0%), reporting a household income less than $35,000 (27.0%) and saying that they had Medicaid or were uninsured (31.5%).
Additional coverage of RSNA 2022 is available here and here.
To read more, go to Radiology Business.
House Committee Requests Changes to Final Surprise Billing Rule
By Victoria Bailey | November 29, 2022
Leaders of the House Committee on Ways and Means have voiced concerns that the final surprise billing rule on the independent dispute resolution (IDR) process continues to violate the No Surprises Act.
Committee Chairman Richard Neal (D-MA) and Ranking Member Kevin Brady (R-TX) penned a letter to the departments of Health and Human Services, Labor, and the Treasury, urging them to revisit the rule.
The interim final rule on surprise billing stated that IDR entities must use the qualifying payment amount (QPA)—the payer’s median contracted rate for an item or service—when determining reimbursement rates for out-of-network services.
The No Surprises Act states that IDR entities should consider the QPA along with other factors, such as provider training and experience, the provider’s market share, and how difficult it was to furnish the service.
The interim final rule received legal pushback, as stakeholders claimed that the IDR requirements did not align with what Congress wrote in the No Surprises Act.
The Biden Administration released the final regulation in August 2022, which aimed to amend the emphasis placed on the QPA during the IDR process. However, the Committee members have expressed concern that the final rule still violates the No Surprises Act.
“Despite a federal district court correctly ruling that aspects of the interim final regulation were flawed in its implementation of the IDR requirements, we are severely disappointed to find that the August 2022 final rule violates the No Surprises Act in the same ways as before,” the letter stated.
“Although the final rule makes some limited progress by no longer designating an unlawful ‘rebuttable presumption’ towards the QPA as the interim final rule did (which a federal district court properly invalidated), we find that the new instruction to IDR entities largely would have the same effect.”
The new final rule directs IDR entities to “consider whether the additional information is already accounted for in the QPA,” creating a double counting test. In addition, the rule says that IDR entities should not give weight to a factor if the information was already accounted for in the QPA calculation.
According to the Committee, these directions continue to skew the determination of the IDR process toward the QPA.
“Even though the No Surprises Act explicitly requires an IDR entity to separately consider all of the statutory factors, the final rule precludes IDR entities from giving weight to factors like patient acuity and the complexity of furnishing the item or service at issue unless providers meet the heightened burden of disproving double-counting within the QPA,” the members wrote.
In addition, factors like market share could fail the double counting test as it could inform an IDR entity’s decision but may also be a variable in the QPA calculation. The double counting instruction fails to acknowledge that neither providers nor IDR entities can accurately evaluate the QPA to determine whether other factors are already accounted for, the letter stated.
The Committee members also pointed out the slow implementation of the Advanced Explanation of Benefits (AEOB) provision of the No Surprises Act. Per the law, the Departments are supposed to implement AEOB requirements by January 1, 2022. However, the Committee is concerned that implementation will be delayed until 2024, given the Departments’ recent request for information.
To read more, go to Revcycle Intelligence.
Google Health Strikes Deal with iCAD to Commercialize Mammography AI
By Heather Landi | November 28, 2022
Google Health struck a deal with medical technology company iCAD to integrate its artificial intelligence technology into the company’s breast imaging solutions.
It marks the first licensing and commercialization agreement for Google Health’s mammography AI models and will integrate the technology into real-world clinical practice, according to the company. ICAD’s tech is used in health systems and imaging centers across the U.S. and globally.
Shares of iCAD jumped 25% after the medical technology company said it has struck a deal with Alphabet Inc.’s Google Health to integrate Google Health’s artificial intelligence technology into iCAD’s portfolio of breast-imaging solutions.
Under the definitive agreement, Google has licensed its AI technology for breast cancer and personalized risk assessment to iCAD. The medtech company will apply the licensed technology to further improve its 3D and 2D AI algorithms and will commercialize developed products.
The companies aim to enhance iCAD’s breast cancer AI solutions for mammography and expand access to the technology to millions of women and providers worldwide, executives said. ICAD will also leverage Google Cloud’s infrastructure, accelerating the time to market for iCAD’s cloud-hosted offerings.
“[I]CAD will work toward validating and incorporating our mammography AI technology with its products for use in clinical practices with the goal of improving breast cancer detection and assessment of short-term personal cancer risk for the more than two million people globally diagnosed with breast cancer every year,” Greg Corrado, Ph.D., head of health AI at Google Health, wrote in a blog post about the deal.
Breast cancer has now overtaken lung cancer as the world’s most commonly diagnosed cancer. More than 55,000 people in the U.K. are diagnosed with breast cancer each year, and about 1 in 8 women in the U.S. will develop the disease in their lifetime.
To read more, go to Fierce Healthcare.
Caught Early, Lung Cancer has 80% Overall Survivability at 20 Years—100% for Some Tumor Types—Yet Few Individuals Avail Themselves of LDCT Screening
By Dave Pearson | November 22, 2022
New findings to be presented at RSNA confirm that lung cancer is highly curable as long as it’s diagnosed early, as is often the case with low-dose CT screenings.
Claudia Henschke, PhD, MD, and colleagues at Mount Sinai Health System in New York City made the conclusion after tracking 20-year survival among 1,285 patients enrolled in the 30-year-old International Early Lung Cancer Action Program (I-ELCAP).
The patients were screened in the program and found to have early-stage lung cancer.
Analyzing this cohort’s associated medical records, Henschke and team found overall 20-year survival hit 80%.
What’s more, they found zero lung-cancer deaths at the 20-year mark among 139 patients with nonsolid cancers and 155 with part-solid cancers.
Additionally, the 20-year survival rate was 92% for patients with Stage 1A cancers that measured 10 millimeters or less.
Twenty-year survival dipped to 73% for the 991 patients who had solid nodules, prompting the researchers to state that lung-cancer consistency is “an important predictor of survival and should be considered in updated staging criteria, as has already been accepted in the pathologic criteria.”
Taken together, the authors suggest in their study abstract , the findings add heft to prior research showing the high curability of lung cancer that gets diagnosed during screening.
In press materials sent ahead of RSNA, the team comments that less than 6% of individuals eligible for LDCT receive it.
This goes far in explaining why just 16% of lung cancers are diagnosed at an early stage—and why the average five-year survival rate for all lung cancer patients is only 18.6%.
To read more, go to Radiology Business.
Medicare Cuts to Physicians Threaten Patient Access and Physicians’ Stability
By Reps. Larry Bucshon, M.D. (R-IN) | Ami Bera, M.D. (CA) | November 14, 2022
America’s physicians are among the everyday heroes who consistently go above and beyond to ensure the health and safety of their communities. They dedicate many years to intense education and training before entering the field, and often face long hours and high stress levels once they begin practicing.
Through their tireless efforts, countless lives have been saved and many others improved—major reasons why medical doctors are considered the most respected profession in the United States.
As physicians, we can say with confidence that the desire to make a difference by providing meaningful care to patients is almost always the primary motivation for pursing such a career.
Unfortunately, most physicians today will tell you that they do not get to spend enough time with patients. Shifting regulations, burdensome paperwork, and regularly changing reimbursement rates require them to spend significant amounts of time on administrative activities.
In 2015, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) with the intent of moving away from a payment model that rewarded physicians for delivering higher volumes of procedures toward a system that would ensure they were paid for the value of the work they do to keep patients healthy. It has become clear, however, that additional reforms are necessary to accomplish this goal.
Under MACRA, an annual publication known as the Medicare Physician Fee Schedule ultimately determines the amounts physicians are paid for services delivered to Medicare patients. Unfortunately, in recent years it has contributed to substantial reimbursement cuts for many providers. This year, the Centers for Medicare and Medicaid Services (CMS) will implement an additional across-the-board reimbursement cut of 4.42 percent.
The last thing our country’s medical providers need right now is a severe cut to Medicare reimbursement, which has the potential to increase health care costs overall and further limit access to quality care.
While we believe that more fundamental reforms are necessary to address the Medicare physician reimbursement structure at large, Congress must also ensure predictability for doctors in the short term.
To that end, we have introduced the Supporting Medicare Providers Act of 2022 (H.R. 8800), a must-pass bill that would delay the proposed cuts for one year while also signaling Congress’s commitment to a long-term policy solution.
Take Action Now!
To read more, go to The Hill.