Interventional clinics move toward self-sustainability

Interventional radiologists find themselves beset by a paradox. The Accreditation Council for Graduate Medical Education requires accredited interventional radiology fellowship programs to have clinics. The American College of Radiology passed a resolution in 2003 supporting interventionalists' clinical endeavors. Yet IRs complain that the clinical nature of their specialty and the revenue they contribute go mostly unrecognized. It's not unusual, for example, for IRs to be faced with a stack of films left by their diagnostic colleagues after a long day of procedures.

"Radiologists' business plan is to have films to read. The business model of an IR clinic is unknown to them and to other physicians inside the same hospital," said Dr. James L. Swischuk, director of the vascular and interventional radiology division at Central Illinois Radiological Associates in Peoria. "Additionally, many radiology departments don't have much of an IR infrastructure and are reluctant to pay for one."

Interventionalists are taking matters into their own hands, and their success is being noted. At this year's Society of Interventional Radiology meeting, several investigators presented studies attesting to the financial strength of IR clinics. Dr. Catherine Tuite and colleagues at the University of Pennsylvania found that radiofrequency ablation and chemoembolization of liver tumors in their outpatient clinic brought in an average of $8000 per patient and generated practice revenues of more than $120,000 annually.

The interventional outpatient clinic at the University of Michigan, which opened in 2003, afforded the radiology department revenue of $1.6 million in 2004, including treatment and follow-up of 137 new patients. Dr. Minchul F. Shin reported that most referrals came from primary-care physicians at the same hospital and from outside gynecologists sending patients with uterine fibroids.

Dr. Rajan Agarwal and colleagues at the University of Pennsylvania examined the contribution IR patients make exclusively in terms of imaging exams. Looking at 1384 patients, they found IR procedures generated more than $200,000 in additional MR and CT exams.

Swischuk and a group of colleagues started an interventional radiology clinic, which, after several years, is making a profit. The outpatient center conducts more than 1000 inpatient consultations per year, including about 3000 follow-up procedures that rely heavily on imaging.

"Other clinical practices, such as cardiology or nephrology, function like interventional clinics. But IR clinics grow slowly because they are developed in a system where patients get referred for images, not interventions," he said.

Health regulatory agencies make freestanding facility designations difficult in some states. As a result, certain IR procedures are not reimbursed. But recent changes by the Centers for Medicare and Medicaid Services to CPT codes for treatments such as percutaneous bone ablation in outpatient centers suggest a new trend for the government, said Dr. Damian Dupuy, an interventional radiologist at Brown University Medical School.

"The government knows it will save money in the long run because hospital overhead is much higher than that of smaller, freestanding facilities," Dupuy said.