Common Fibroscan Technology Questions
Podcast Transcript
Original Air Date: June 20, 2022
Introduction: Welcome to the MedEvidence podcast, hosted by Dr. Michael Koren and Michelle McCormick. MedEvidence, where we help you navigate the real truth behind medical research with both a clinical and research perspective. In this podcast, we'll have discussions with physicians that have extensive experience in patient care and research. How do you know that something works in medicine? We conduct clinical trials to see if things work. Now let's get the truth behind the data. Welcome to MedEvidence, powered by ENCORE Research Group. Go to Encoredocs.com.
Dr. Koren: I'm Dr. Michael Koren, and I'll be sharing the stage with my good friend Dr. Bharat Misra here for our MedEviedence! Hour. And we've been talking about Fibroscan technology, which is a form of what we call ultrasonic elastography, using ultrasound waves to study the liver. And we're looking at it, particularly for Fatty Liver Disease, which we will talk more about. That's a real scourge right now. So Dr. Bhrart Misra is here to join me. And we were talking about the value of this technology and the fact that lots of folks don't get it because the reimbursement to practices is so poor. But we do have this technology available in the research setting. And so the question, Bharat, is which patients should get fibrous? Getting should everybody get it? Like, you turn 18, you're about to get your driver's license. Should you get it? Should you get it when you're 21 and you're going to go out to the bars and see if your liver is predisposed to these things or who should have it. So let's talk a little bit about who you think should be screened for this particular type of issue with the Fibroscan.
Dr. Misra: Sure. Just to give you some numbers, about 100 million people in the United States have Fatty Liver. That's one in three. And about a quarter of them has a more serious form of Fatty Liver, where the liver starts getting scarred up, which is called NASH. So if you look at those numbers, you'd be tempted to say, everybody, that's one in three. That's very prevalent but of course, insurances are not equipped to handle that kind of load, so we have to be a little bit selective. So the way I would put it is anybody who has been diagnosed with Fatty Liver by another method or suspected Fatty Liver because of risk factors. So the classic indication is you go to your doctor, your liver tests are a little bit high, your waistline is a little more than it should be, and the doctor orders an ultrasound, and the ultrasound shows that you have fatty liver. That is the ideal patient for Fibroscan because you've ruled out any structural diseases of the liver. Now you want to know how bad is it? How worried should I be? And that's the ideal candidate. But I think physicians who see people with something called metabolic syndrome, that's a big name for this condition in which you get a little overweight and diabetes is the central part of it. Anybody with metabolic syndrome, and we'll come to that a little bit later, should have a Fibroscan.
Dr. Koren: I think they changed the name from metabolic syndrome to typical American.
Dr. Misra: Yeah, we're being flippant. But that is, you throw a stone and you'll hit somebody with metabolic syndrome. It's that prevalent. And in addition, if you have had a liver biopsy done the gold standard test, well, two years later, you go to see a doctor and you ask him, how's my Fatty Liver? Well, you can't do another liver biopsy, you do a Fibroscan. The advantage to a Fibroscan is it can be done repeatedly. You get a sense of whether what you're doing is working or not. So suspected Fatty Liver or Fatty Liver diagnosed by any other methodology should be followed up, in my opinion, with a Fibroscan. And you have your baseline, and then you can repeat it every two years, for example, and see how you're doing.
Dr. Koren: So should we be going to flea markets and screening people? Should primary care physicians be ordering this routinely? Give us a little bit more insight into the setting that you see is best to use this technology.
Dr. Misra: As we had mentioned, this could be everybody. So clearly it's an underutilized test. And primary care physicians know who is at risk of Fatty Liver and they should be ordering this test on all those patients. And a lot of those patients, patients who are overweight BMI above 30, patients who have abnormal liver tests, patients whose abdominal girth is higher than it should be for their age, patients who are prediabetic or non-diabetes, that's the patient that should get a Fibroscan. And I like Fibroscan in flea markets and at Whole Foods. In other words, it is so prevalent that once people see an easy test, they know they are at risk and they come up, get a diagnosis, and it makes them more motivated to take steps to reverse the process.
Dr. Koren: Yeah, I was just thinking that if we did it at flea markets, we may be able to patent and then market a belt that when you loosen it more than two notches, it says, time for a Fibroscan. That might be a good idea.
Dr. Misra: It can be done everywhere. And because it's so prevalent, I think any setting where a third of the patients are going to be positive, you can do it everywhere.
Dr. Koren: So should the average patient as their primary physician to get a Fibroscan, is that reasonable or how would that be looked at?
Dr. Misra: I think that would be a good idea. I think at least primary care physicians and gastroenterologists are truly aware of the epidemic of Fatty Liver. It is a true epidemic, increasing year by year. And what they may not be aware is that we do have fibroscanning now available in Jacksonville and all you have to do is pick up the phone and call ENCORE Borland Grover Clinical Research or ENCORE Research, and you can schedule a free Fibroscan. So it's available, and more people should be picking up the phone and ordering it. And if it takes a request from you to your primary care physician, I think that's okay.
Dr. Koren: Yeah, it's actually a really neat benefit for people who are part of the ENCORE Research family, including people that are working through the joint venture of ENCORE Research with the Borland Grover Clinic. So it's a tremendous resource for the community because, quite frankly, there's very limited access to Fibroscanning outside of research.
Dr. Misra: And I have to tell you, we had a demonstration for our physicians. We had an expert speaker who came to talk about Fibroscan, and we had a Fibroscanner there, and we said, does anybody want to try the Fibroscan? Everybody in the conference lined up, and the meeting was over. People had gone on, but people waited, including myself, to get my Fibroscan. So we're all curious, and I think it's such an easy, safe test. It should be standard of care for many of our patients.
Dr. Koren: Now, you mentioned Jacksonville, but just to be fair, we actually have the capability throughout Northeast Florida, and we also have it in the Tampa area.
Dr. Misra: That's right. We are really a Florida-based organization. And this is true for not just Florida, but for anyone. Anybody listening to this podcast anywhere in the United States, ask your doctor for a Fibroscan. It is safe, and easy, and you will get a quantitative measure, which is really very valuable.
Dr. Koren: Now, you mentioned that insurance has been a tricky issue regarding reimbursement for Fibroscanning. Is there any available for people to get this fee for service and what charge would be reasonable? Let's say somebody really wanted it and they're willing to pay for it out of pocket.
Dr. Misra: So the Medicare allowable is very low. It's about $30, $40. But it is available. And since it's very inexpensive, insurance companies will not have a hard time. So, yes, if you have heard of anywhere there is a Fibroscan available, you can have your doctor order it. However, there is a reimbursement code for it, which goes up a little bit more if you have commercial insurance.
Dr. Koren: Okay. Now, are there any age limits that you would suggest? Is there anybody too young or too old to get Fibroscans?
Dr. Misra: Unfortunately, no. As you know, pediatric obesity is the fastest rising age group in the United States. I see 16 year-olds with a BMI of 40 routinely, and they are just as high a risk of Fatty Liver as other adults. So, you don't want to do it in babies. But I think maybe starting in the teenage years, anybody who is overweight and is at risk should have this information.
Dr. Koren: And just to remind them, I know when you're 16, you sometimes doubt your mortality, but you can't live without a liver.
Dr. Misra: That is right. And as somebody pointed out, it's in the name L-I-V-E--R.
Dr. Koren: Again, for those of you who are younger out there that think you're indestructible here's, a bulletin you're not, and knowing about things earlier rather than later may be a motivation to get on the right track. Let's talk about one last thing before we change segments. Fibroscanning. Are there any particular providers that have more or less expertise? For example, are there stand-alone places where you can get it? Or is it something that has to be only through trusted physicians? How do you know you're getting good data? And then the other thing I'd like for you to follow up on is, okay, you have an abnormal study. Do you freak out? And what are the next steps?
Dr. Misra: Okay, so Fibroscan is not very prevalent, as we had mentioned prior, Borland Groover has one and ENCORE Research has a couple of them, and there are freestanding facilities that only do Fibroscan in some other states. They advertise on billboards about doing Fibroscan. Again, it's so easy to do. A standalone center can very well do it. They just do Fibroscan.
Dr. Koren: And you can trust them. You think so?
Dr. Misra: Yes, it's idiot proof, the technology. In other words, after you've done a few and I've done a couple of myself, it's actually very easy to use. You take a probe and point it at the liver, and the machine does the rest of the work for you, and it gives you the readings. And then the readings are standardized across the nation, across the world, and based on the numbers, they give you a score. And all this is done by the machine itself. Your job is to make sure you point it at the liver and not something else. So I think quality is not as big an issue. The question is, what do you do once you get your fibro scan? Anecdotally? Our CEO, called me once. He had a patient with a Fibroscan which showed he had cirrhosis. So he sold his house, wrote his will, and followed up wanting to know his life expectancy. A Fibroscan is a good screening test, a good starting test, but it's not the last test. You might need additional workup. You might need a liver biopsy. You might need an MRI. You might need to be referred to a clinical trial for treatment. So don't freak out about the results. Once you get the result, you take that printed copy and go to your primary care physician or your gastroenterologist to find out what does that actually mean for you? And I think that will be a very fruitful discussion.
Dr. Koren: The most important advice that we can give to patients at this point is what you just said, which is why I think you should be a guru on the mountain, which is don't freak out.
Dr. Misra: Yeah, I think so. And no test is 100%. They all have their limitations, and it's a piece of the puzzle. It's a very important piece, and it's an easy to access piece. But then you have to look back. Maybe that Fatty Liver is from that six-pack that you've been doing every day, and that is easily fixable. So what we call Fatty Liver is there are many diseases that can cause this.
Dr. Koren: So our next segment, we're going to delve into more specifically what those diseases are and what we can do about them.
Michelle McCormick: I'm your host, Michelle. McCormick, and we want to thank Dr. Michael Koren for his clinical and research perspective behind the science in this episode of MedEvidence! the Truth behind the Data.
