Historically, mention of interventional radiology conjured up thoughts of vascular techniques. Today, this area of radiology encompasses much more – in fact, according to industry experts, it’s growing quickly and is expanding heavily throughout health care as a whole.
But, what’s behind this extension, and how has it – and will it – affect diagnostic radiology?
These changes, said Matt Hawkins, MD, director of pediatric interventional radiology (IR) at Emory University School of Medicine, will likely change the health care landscape in the years to come.
“Interventional radiology will play a bigger role moving forward,” he said. “As we measure the overall cost and value, we can do a lot in interventional radiology that costs less and positively impacts patients.”
Interventional Radiology’s Changing Face
For many years, IR was used mainly to make cardiovascular procedures less invasive, but in recent years, these techniques have been applied to other specialty areas, as well, according to the Advisory Board. In addition to medical oncology and pediatrics, IR is gaining ground in neurology, gastroenterology, and urology.
A Transparency Market Research report indicated the most common IR procedures include angioplasty, venous access, biopsy, fibroid embolization, stents, arteriograms, and embolization.
Providers are using IR more frequently in these ways because the techniques are more cost effective, less disruptive to the body, and can be done in the outpatient setting. Based on the Advisory Board analysis, increased use of IR in research is strengthening the quantitative data to support IR’s value in radiology as a whole.
What’s Driving IR’s Growth?
As the health care industry morphs with new payment models, a greater focus on patient satisfaction, and value-over-volume, IR has become increasingly attractive, Hawkins said. Much of its popularity revolves around it being “less.”
1. Less invasive: By using image-guided wires, catheters, and stents, IR and its practitioners provide minimally-invasive procedures. Avoiding incisions and longer recovery times is popular with both referring providers and patients.
“The fundamental core principle to finding new ways to do things is to be less invasive,” he said. “Without incisions or stitches, it’s very appealing to patients, and it’s leading to more potential IR growth.”
2. Less procedure-driven: The focus for IR providers has begun shifting away from only conducting procedures. Instead, they’re beginning to concentrate on greater patient contact – seeing appointments in outpatient settings, rounding on patients in hospitals, and conducting inpatient consults.
3. Less cost expenditure: In an effort to control costs, the health care industry now pays close attention to the price tags associated with all clinical care services. With the image guidance available through IR, providers are able to visualize problems faster, conduct procedures in less time, and quicken recovery times, said Jonathan Flug, MD, MBA, assistant radiology professor at the University of Colorado-Denver School of Medicine.
“Clinical colleagues are under pressure to get patients out of the hospital faster to keep costs down,” he said. “So, a lot of providers refer to interventional radiology to see where we can help out.”
4. Less traditional approaches: As a subspecialty, IR is in the unique position to be innovative leaders in both radiology and health care as a whole. Because IR providers work with referring physicians from a variety of subspecialties, Flug said, they can glean best practices from each group and leverage them for new techniques that might not be readily apparent to their clinical counterparts.
Impacting Patient Care and Demonstrating Value
As IR continues to grow and more hospitals open IR departments, Flug said, it’s rapidly becoming the face of radiology for a large population of patients, particularly with breast and musculoskeletal imaging. These patients are more likely to have a face-to-face encounter with a radiologist who will conduct an image-guided procedure than they will the one who reads their study.
In many instances, he said, patient care truly begins only after IR has become involved. For example, in large multi-disciplinary or academic medical centers, IR providers are frequently asked to conduct tumor biopsies. Although doing so is not necessarily considered emergent, the rest of a patient’s care plan can’t proceed until the biopsy is complete, making IR an integral part of patient care.
In addition, many within health care are already seeing IR’s impact and the value it brings to the table, Hawkins said. These benefits are particularly evident with complex patients. In those cases, the diagnostic training IR physicians have enables them to pinpoint what procedure must be done for each patient quickly. In the same vein, that knowledge reduces the number of inappropriate images and controls resource consumption.
Anecdotal evidence has already emerged that IR procedures demonstrate cost savings in terms of dollars conserved, fewer inpatient days, and less significant suffering and symptoms. Research is needed, though, to validate these observations, Flug said.
“We like to believe that we have a big impact on patient care,” he said. “But, the onus is on us to prove and show that.”
Relationship with Diagnostic Radiology
Largely, diagnostic radiology (DR) and IR go hand-in-hand, one used to highlight a problem, the other employed to fix it. As such, DR has traditionally been a consistent referral base for IR.
However, both Hawkins and Flug said, the more IR has grown, the more it has diverged from DR. That’s a change the radiology industry should try to ward off, they said.
“The more interventional radiology grows, the less alike diagnostic and interventional radiology are,” Hawkins said. “Many IR doctors feel less and less a part of diagnostic groups.”
While IR providers continue to foster an identity separate from DR providers, in an effort to be seen as clinical colleagues in their own right, the new interventional radiology-diagnostic radiology residency continues to grow. The hope is that, while these separate identities can solidify, the segmentation that makes IR providers feel alienated will begin to fade. The goal, Hawkins said, is for both IR and DR to become more patient-centered simultaneously.
Awareness for what IR brings to the radiological table is growing, but the subspecialty still faces challenges. As of yet, there’s no industry-wide consensus on how best to seamlessly integrate IR providers into hospital diagnostic departments, Flug said. Groups are often plagued with questions of how to best divide responsibilities. Ultimately, however, he said, both radiology factions should be tied together.
“It’s important to keep interventional radiology and diagnostic radiology together because the last thing we want to see is IR as its own specialty,” he said. “Radiology as a whole would lose the benefit of having a more clinical-facing facet.”
On a day-to-day basis, though, IR and DR providers must be treated differently. Call schedules must be designed around their individual duties, and workflow and productivity expectations must be based on their responsibilities. In addition, their expected RVUs will differ with varying workflow.
Even with the differences and the existing sense of segmentation, IR and DR providers can improve their relationship, Flug said. Open and frequent conversations can help providers determine best practices for diagnosing patients and providing the best follow-up care possible.
By working together, Hawkins said, IR and DR providers can demonstrate radiology’s importance within the greater health care system.
“Where interventional radiology will bring value to health care will be by being patient-centered and strengthening the link with diagnostic radiology,” he said. “And, they should look to increase their opportunities to showcase that value.”