The Lure and the Legend of Office-based Interventional Radiology

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By the nature of their subspecialty, interventional radiologists are enamored of innovations that engender emerging minimally invasive therapies, and the 2011 annual meeting of the Society of Interventional Radiology (SIR) in Chicago, Illinois, did not disappoint. Interventional-radiology researchers reported promising outcomes from clinical trials for stroke therapy, multiple-sclerosis treatment, and catheter-based treatments for hypertension.

“New emerging therapies will define interventional radiology,” Timothy P. Murphy, MD, FSIR, told attendees of “Freestanding IR: Economics, Politics, and Business of IR: A Mini MBA,” on March 26. Murphy is the newly inducted president of SIR, medical director of the Vascular Disease Research Center of Rhode Island Hospital in Providence, and a professor at Brown Medical School.

Traditionally, interventional radiologists have delivered their services in hospital settings, often unbeknown to patients with stroke, gastrointestinal bleeding, gunshot wounds, and obstetric emergencies. A growing number of interventional radiologists, however, seek the autonomy to control their own destinies—outside the confines of the hospital—in freestanding clinics.

During a half-day business-development session that described the pros and cons of freestanding interventional-radiology clinics, no clear model emerged, and many caveats were voiced. Business strategists, for instance, caution interventional radiologists (and their diagnostic-radiology partners) to remember that the hospital is a very important customer, much as the referring physician is. Murphy notes that the hospital delivery model is not absolutely essential, though it is very important.

A market is emerging, nonetheless, for the outpatient delivery of interventional services as discriminating patients want to know how minimally invasive treatment alternatives compare (in price and outcomes) with surgery or medication. These patients often have debilitating or life-threatening diseases that have not improved in response to other therapies.

An Independent Streak

According to the 17 presenters of the half-day symposium, interventional radiologists gravitating to the freestanding setting prefer the flexibility to schedule patients, to define their case mixes, and work from central offices. Many minimally invasive procedures, however, still require inpatient admission, so whether they work as independent practitioners or in hospital–radiologist joint ventures, more and more interventional radiologists seek the opportunity to meet patients and counsel them about treatment options before their procedures and to follow them throughout their therapy regimens.

The greatest challenge for a freestanding interventional-radiology clinic, Murphy says, is to break even—which might be as simple as adding a new procedure that will take the operation into the black. The first challenge, however, will be to overcome the interventionalist’s reputation as a therapeutic technician and win the confidence of referrers and patients for evaluation/management expertise.

If the interventional radiologist isn’t ready to go solo, another option is a joint venture with the hospital. “Everyone benefits,” Murphy says. “Currently, patients with ambulatory conditions go to the hospital, but hospitals are designed for acute care. Parking isn’t good. In contrast, an interventional-radiology office should be designed for convenient access and patient comfort, and should have a well-trained office staff.”

In those scenarios in which an interventional radiologist is employed by the hospital, the hospital typically designates the interventional-radiology budget as a subcost and manages downward, Murphy notes. In this case, interventional radiology is considered an ancillary service, is often operating under capacity, and is most likely to need resources. When a progressive hospital executive sees interventional radiology as a growth area and collaborates with the interventional radiologist in the development of new services, however, investment can follow—and a joint venture can evolve.

In the end, hospitals might not recognize the subsequent procedures that stem from interventional-radiology services, nor might they be tracking those data. Murphy explains that SIR is actively working to document the return on investment of interventional-radiology services. Moving forward with a freestanding interventional-radiology center or a joint-venture outpatient