Interventional radiologists, like their diagnostic counterparts, remain under pressure as payers ratchet back reimbursements. But they continue to fight on the reimbursement front and see some silver linings in new government programs designed to improve the quality of care.

Interventional radiology practitioners and researchers, as well as IR-related technology developers, could use to their advantage federal plans such as the Physician Quality Reporting and Critical Path initiatives. Such plans may help them to streamline workflow, protect reimbursement, and bring about better drugs and devices more quickly and cheaply, according to members of a panel presentation at the recent Society of Interventional Radiology meeting.

A white paper published in 2003 by the American College of Radiology Task Force on Interventional Radiology noted that the onslaught of competing specialties would push interventional radiology out of business unless it were willing to make the outpatient clinic model its cornerstone. Until then, IRs had been traditionally trained as hospital-based physicians who stayed out of the evaluation and management side of patient care.

The publication of that paper started a revolution. The trend toward clinically oriented care in outpatient clinics operated by IRs became all the rage—until Congress passed the Deficit Reduction Act of 2005, which snowballed into a series of policymaking efforts to contain imaging costs.

The new plans laid out by Congress and the Centers for Medicare and Medicaid Services since 2007 have hit interventional radiology hard. CMS rules for the 2008 Hospital Outpatient Prospective Payment System, published late last year, imposed a bundled approach to reimbursement that mixes technical components of imaging guidance, such as contrast media use, with therapeutic aspects that had traditionally been billed separately.

SIR supports the concept of bundling but questions its implementation. Under the proposed rule, for instance, the CPT code 37210 for uterine artery embolization was assigned the ambulatory payment classification code 0202, with a payment rate of $2720.36, using the bundling approach. SIR complained that this APC code did not make up for UAE's intensive use of device and imaging resources. The society proposed instead APC 0229—used for intravascular cathether and shunt placement—as more appropriate and having a rate ($5639.26) more in line with UAE's actual technical, professional, and resource demands. CMS ultimately adopted SIR's advice regarding UAE. It ignored similar recommendations, however, for a host of other procedures.

Reimbursement bundling may discourage CT or MR guidance in favor of cheaper modalities such as fluoroscopy and ultrasound, according to ACR and SIR officials. It could also affect the availability of vital interventional services such as angioplasty and stenting. The ACR's Economics and Health Policy Department predicted that IRs could face a loss of about a quarter of their revenues through the new HOPPS regulations. To add insult to injury, the National Correct Coding Initiative has turned into another aggressive policymaking tool to rein in reimbursement, SIR officials noted at the annual meeting. CMS had originally started the NCCI in 1996 to hinder improper coding.