A common service for dialysis patients costs about $100,000 less when delivered by an interventional radiologist rather than a surgeon, according to study published Tuesday.
More than 600,000 patients each year require life-saving hemodialysis for end-stage renal disease. And such care is a costly proposition, with $34 billion spent each year in fee-for-service Medicare, largely for creating and maintaining conduits, noted experts with the University of Colorado.
Fewer than 50% of all access conduits for dialysis remain viable for longer than three years and clinical guidelines recommend regular surveillance to guard for signs of impending failure. Interventions such as angiography, angioplasty stent placement and thrombolysis are typically performed by radiologists, surgeons or nephrologists. But it appears that interventional imaging physicians’ work in this realm costs tens of thousands less, underlining the subspecialty’s value proposition, and an opportunity to save significantly in the Medicare program, experts advised.
On average, the cost per patency year of dialysis in Medicare landed at roughly $174,000 for surgeons compared to $89,000 for nephrologists and $71,000 for radiologists.
“Discrepant use of the operating room and anesthesia services accounted for substantial payment differences across specialties,” Premal Trivedi, MD, an assistant professor in vascular and interventional radiology, and colleagues wrote Sept. 8. “Utilization of operating rooms and anesthesia services should be scrutinized moving forward. Reducing and eliminating the use of these high-cost resources would achieve major systemic savings,” the team added later.
To reach their conclusions, Trivedi and colleagues analyzed data from nearly 1,500 Medicare beneficiaries who underwent their first arteriovenous access placement in 2009. They then tracked subsequent use of healthcare services after the intervention for five years following that placement.
All told, 8,166 maintenance interventions were performed in the study population through 2014, with an unadjusted mean Medicare payment for each incremental year of patency at $71,000 for radiologists. When adjusting for clinical severity and location, intervention type and resource use, surgeons were paid 59% more than rads while nephrologists collected a 57% higher payment. Use of the OR and anesthesia were the biggest drivers of this difference, Trivedi et al. reported, accounting for 407% and 132% higher payments, respectively. Surgeons also placed stents significantly more often than other physicians, resulting in a twofold increase in costs.
In a corresponding editorial, Sarah White, MD, noted that interventional radiology has always been “plagued” by the need to prove its value to both referrers and hospital administrators. She hopes those parties take notice of this information.
“For surgeons and nephrologists to offer services at a cost similar to interventional radiology, they need to adopt the interventional radiology model, which has demonstrated significant financial benefits and decreased the financial burdens of dialysis maintenance, noted Smith, who is an associate professor of radiology and surgical oncology at the Medical College of Wisconsin. “Until other specialties can match the cost of care provided by interventional radiologists, referring physicians and patients themselves should consider seeking care from interventional radiologists.”
You can read the entire analysis in Radiology here and Smith’s editorial here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.