In recent years, interventional radiologists have had an easier time with the long-standing challenge of impressing their diagnostic colleagues with the intangible worth of a clinical interventional-radiology service. A radiology practice with clinical feet on the street has at least a fighting chance of outrunning a remote teleradiology service.
Gregory Soares, MD, director of interventional radiology at Rhode Island Hospital in Providence and a member of the megapractice Rhode Island Medical Imaging (RIMI) in Providence, took this mission a step further and devised a system for quantifying clinical interventional radiology’s tangible value. He shared the model that he used to measure interventional radiology’s contribution to practice RVUs at the Annual Summit of the RBMA in New Orleans, Louisiana, on June 6, 2011.
“Diagnostic imaging groups devalue—and should—evaluation/management services,” Soares says. During the half hour that an interventional radiologist spends on an initial evaluation/management visit, which is worth 3.93 RVUs in the 2009 Medicare Physician Fee Schedule (MPFS), a diagnostic radiologist can read four noncontrast brain CT exams (worth 6 or more RVUs in the 2009 MPFS). The value, he continues, is not in the initial episode of evaluation/management; it is the downstream revenue generated by the clinical contact.
The tangible value of a clinical interventional-radiology service includes direct revenue generation (procedural and evaluation/management reimbursement) and indirect revenue generation (imaging and downstream imaging) that Soares calls the ripple effect.
Barriers to Clear
Soares emphasizes that anyone interested in applying the algorithm first needs to establish certain measurement assumptions. In order to identify the interventional-radiology revenue bucket, the practice must define what interventional radiology is in the practice. “Is it the interventional radiologists in the fluoroscopy suite, doing traditional interventional-radiology procedures, or does it include the people down in CT and ultrasound, doing biopsies and drainages?” he asks. “Are ablations interventional-radiology procedures?”
For the purpose of understanding the costs of the interventional-radiology program, a practice must identify those radiologists who do interventional procedures. This could be restricted to radiologists defined as interventional radiologists or could include all radiologists with interventional-radiology fellowships, those who have a certificate of added qualification in interventional radiology, or anyone who puts a needle in a patient.
In order to perform appropriate assignment of the dollars attributed to interventional radiology, a practice must establish a revenue center that is a hospital-based revenue center, a modality revenue center, an office-based revenue center, or a combination of all three. In a complex practice such as Soares’ environment, this can be challenging, but it is not impossible.
Other requisite tools include people with interventional-radiology coding expertise; a billing program with basic data-mining capabilities (for instance, the ability to identify procedures by patient and define where this work was done); someone in the IT department who is willing to perform the searches; and time.
This algorithm is based on indexing the CPT® codes that define the patient’s initial clinical contact with your group during the time frame under investigation—2008, in the case of RIMI. With subsequent queries of the data, it is possible to identify the downstream revenue that each of those clinical contacts generates and to eliminate codes that are not attributable to the interventional-radiology practice.
In preparation for applying the algorithm, compile an exhaustive list of the interventional-radiology codes for your practice, including everything that your interventional radiologists do and nothing that your interventional radiologists don’t do. For RIMI, that added up to 708 distinct codes, including procedural and evaluation/management codes. “This is what you are going to use to probe your group’s billing data,” Soares says.
Query 1: This first query of the database defines all interventional-radiology charges performed during a designated time period, including all charge codes submitted for interventional-radiology procedures and evaluation/management work. It provides an initial list of interventional-radiology procedures, as well