RESUMEN
As reimbursement from the Medicare Physician Fee Schedule (PFS) continues to decline, cuts to practice expense relative value units disproportionately impact office-based interventionalists and private practices that rely on high-cost equipment. For 195 codes, specialties such as radiation oncology, vascular surgery, and interventional radiology are paid at rates less than their direct costs calculated by the Centers for Medicare and Medicaid Services itself. While reimbursement in the office-based setting continues to decline, high-cost hospital settings receive more payment for the same services. This disparity aligns with trends in care moving to the hospital setting and practice consolidation, resulting in increased costs to the healthcare system and decreased access to care. The current PFS is outdated, and the removal of high-cost supplies and equipment from the PFS is a critical step to reform.
RESUMEN
The physician office offering imaging guided endovascular and minimally invasive interventional procedures is often referred to as an OBL (office based lab), OIS (office interventional suite), or OES (office endovascular suite). Initially, OBL's depended upon the national societies of interventional radiology (SIR), vascular surgery (SVS) and interventional cardiology (SCAI) to advocate for them. However, the OBL space needed a voice dedicated to advocating for the appropriate reimbursement of procedures in the OBL to allow the OBL to survive as a viable site of service and become integral to healthcare delivery in the US healthcare system. This need led to the formation of the Outpatient Endovascular & Interventional Society (OEIS). The society is multispecialty and ensures safety in outpatient care in all sites of service while maintaining a focus on the OBL. The mission of the OEIS is to advocate for patients to have the ability to choose their provider and be able to receive safe and effective healthcare in a more friendly and far less costly site of service for them.
Asunto(s)
Atención Ambulatoria , Procedimientos Endovasculares , Radiografía Intervencional , Sociedades Médicas , Humanos , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Historia del Siglo XX , Historia del Siglo XXI , Objetivos Organizacionales , Defensa del Paciente/historia , Radiografía Intervencional/historia , Sociedades Médicas/historia , Estados UnidosRESUMEN
PURPOSE: To assess the attitudes of interventional radiologists (IRs) and diagnostic radiologists (DRs) toward exclusive contracts and independently practicing IRs who may request privileges at a hospital where an exclusive contract exists with a different group of radiologists. MATERIALS AND METHODS: A total of 22,400 survey instruments were distributed to 4,490 IRs and 17,910 DRs in the United States. Statistical evaluation included multivariate ordinal logistic regression analysis with calculation of the odds ratios and forest plots. RESULTS: Completed surveys were received from 525 (11.69%) IRs and 401 (2.23%) DRs. Given the low response rate of DRs, data analysis was focused on IRs. Early-career IRs and those in outpatient practices had a more positive attitude toward independent IRs who requested admitting and/or procedural privileges. A supermajority of both IRs and DRs who responded to the survey agreed that the importance of IR to hospital and health system contracts will increase. CONCLUSIONS: This survey identified many interrelated and complex variables that significantly affected the attitudes of IRs in various practice settings toward independent IRs requesting hospital admitting and/or procedural privileges. It will benefit independent IRs seeking admitting privileges to better understand some of the factors that impact the potential willingness of the radiology groups and other IRs with exclusive hospital contracts to work toward mutually beneficial practice paradigms, especially as more clinically oriented IRs complete their training in the new, integrated residency programs.
Asunto(s)
Servicio de Radiología en Hospital , Radiología Intervencionista , Humanos , Estados Unidos , Radiología Intervencionista/educación , Radiólogos , Encuestas y Cuestionarios , ActitudRESUMEN
Autologous blood patch pleurodesis (ABPP) offers an alternative to surgery when conservative management is ineffective for treating a persistent air leak (PAL). In the traditional technique, autologous venous blood is introduced into the affected pleural cavity via a blindly inserted large-bore surgical chest tube. Herein, we present a case of an 18 year old male with a PAL following video assisted thorascopic bleb resection and talc pleurodesis who underwent successful ABPP using a small-bore pigtail catheter placed under computed tomography (CT) guidance. As compared to the traditional technique, this approach may potentially offer several advantages, such as more precise chest tube placement over the air leak site and reduced pain with chest tube insertion. Although image-guided chest tube insertion is a commonly performed procedure, its use for the specific indication in this patient's case has not been described in the literature, to the best of our knowledge.
Asunto(s)
Tubos Torácicos , Pleurodesia/métodos , Adolescente , Tratamiento Conservador , Humanos , Inyecciones , Masculino , Neumotórax , Tomografía Computarizada por Rayos XRESUMEN
Contracting is an important part of running the business of private practice interventional radiology. A basic knowledge of contracting is vital for the practicing interventionalist to best position him or herself to excel in private practice. Exclusive contracts are common in interventional, diagnostic, and radiology practices. Such contracts, however, may significantly limit the practice of individual interventional radiologists and impede the growth of interventional procedures in communities at large. This article outlines the role of exclusive contracts in interventional practices, and describes the limitations of such contracts.