Walmart implements a narrow network for diagnostic imaging

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Starting last March, retail giant Walmart now requires that its employees use a select network of 800 diagnostic imaging providers, or face additional out-of-pocket costs, according to an article this week from Kaiser Health News. Lisa Woods, Walmart’s senior director of benefits design, said high error rates in imaging studies were the driver for establishing the program, with the perspective that “a quality MRI or CT scan can improve the accuracy of diagnoses early in the care journey.”

The network was created in partnership with New York-based Covera Health, a technology company that has amassed information on thousands of imaging facilities nationwide, and uses independent radiologists to evaluate a sample of studies to determine facility and radiologist error rates. According to the article, while many employers have steered employees to lower-cost imaging networks, Walmart is the first to do so based on quality of the studies.
 
Whether this network will be effective in achieving its stated goal—reducing misdiagnoses that lead to unnecessary care and surgery—remains an open question. Poor-quality imaging undoubtedly leads to repeat studies, which carry significant costs. But many other factors (clinical judgement, incentives, patient preferences) contribute to the decision to perform surgery. Defining imaging “quality” beyond the blunt measures of repeat rates, technical adequacy and radiologist sub-specialization is highly complex, and requires correlation with pathology and clinical outcomes data—a high bar for an outsourced analytics provider.

Despite Walmart’s goals, it will be difficult for imaging providers to differentiate their services solely on quality. The high variability in imaging prices is well-documented, and choice of provider is largely made by consumers, for whom imaging is a commodity service.

Without an activist employer or payer to steer them, consumers will likely continue to choose their imaging providers based on their doctor’s recommendation and out-of-pocket costs.

 

Healthcare CEO faces life in prison for fraud that led to 2 patient deaths

http://www.beckershospitalreview.com/legal-regulatory-issues/healthcare-ceo-faces-life-in-prison-for-fraud-that-led-to-2-patient-deaths.html

Fraud

The CEO and co-owner of a Maryland diagnostics company is facing life in prison after a federal jury convicted him of two counts of healthcare fraud that resulted in death, according to the Department of Justice.

On Wednesday, a federal jury found 67-year-old Rafael Chikvashvili, PhD, guilty of healthcare fraud. Dr. Chikvashvili was the co-owner and CEO of Owings Mills, Md.-based Alpha Diagnostics, which was a portable diagnostic services provider, principally of X-rays.

According to evidence presented at trial, Dr. Chikvashvili was involved in a scheme to defraud Medicare and Medicaid. He and others allegedly conspired to create false radiology, ultrasound and cardiologic interpretation reports. He also allegedly submitted insurance claims for medical examination interpretations that were never completed by licensed physicians, according to the DOJ.

Dr. Chikvashvili allegedly instructed his nonphysician employees to interpret X-rays, ultrasounds and cardiologic examinations, which, according to testimony provided at trial, resulted in two patient deaths.

Radiologists Take On Bigger Role in Diagnosing

http://www.wsj.com/articles/radiologists-take-on-bigger-role-in-diagnosing-1468261106?utm_campaign=KHN%3A+First+Edition&utm_source=hs_email&utm_medium=email&utm_content=31540667&_hsenc=p2ANqtz-_0Pi-yLJKkgRXeSz30YgGrRQJo-l6X7K8_V5U8he3tQDl1M1kRhpstr8Ok1FboF5hRM12Pdh6HySpemIkTlJVY7kWWig&_hsmi=31540667

Dr. Michael Recht, head of radiology at NYU Langone, has been working to more closely integrate his fellow radiologists with the hospital’s clinical teams. Radiologists shouldn’t simply interpret images but should also help with medical decision-making.

The doctors who interpret imaging scans have begun working more closely with physicians who make medical decisions for patients at NYU Langone Medical Center.

Hospitals Bet on Neuroscience

http://healthleadersmedia.com/content.cfm?topic=PHY&content_id=325140

Emerging Technologies 1

Healthcare executives believe the neuroscience service line is primed for delivering better and more coordinated care. OSF HealthCare, Carilion Clinic, and Stanford Health are making big investments in patient-centric facilities and state-of-the-art equipment.