Why Vascular Surgeons and Interventional Radiologists Collaborate or Compete: A Look at Endovascular Stent Placements

Evolution of the Interventional Radiology (IR) Pathway-Various Changes and Interrelation to Diagnostic Radiology (DR)

Interventional radiology continues to evolve into a more robust and clinically dynamic specialty underpinned by significant advancements in training, education, and practice. This article, prepared by members of the 2020-2021 Association of University Radiologists' task force of the Radiology Research Alliance, will review these developments, highlighting the evolution of interventional radiology pathways with attention to growing educational differences, interrelation to diagnostic radiology training, post-training practice patterns, distribution of procedures and future trends, amongst other key features important to those pursuing a career in interventional radiology as well as those in practice.

Nationwide Trends in Catheter-Directed Therapy Utilization for the Treatment of Lower Extremity Deep Vein Thrombosis in Medicare Beneficiaries

PURPOSE

To determine overall and provider specialty trends in the use of catheter-directed therapy for lower extremity deep vein thrombosis (DVT) treatment in the Medicare population.

MATERIALS AND METHODS

Using data obtained from 2007-2017 Centers for Medicare & Medicaid Services 5% research identifiable files, all claims associated with acute and chronic lower extremity DVT were identified. The annual volume of 2 services-venous percutaneous transluminal thrombectomy (current procedural terminology [CPT] code 37187) and venous infusion for thrombolysis (CPT code 37201 from 2007 to 2012 and CPT code 37212 from 2013 to 2017)-was examined for trends in DVT intervention. Utilization rates based on region and the place of service were calculated. The results were further categorized based on primary operator type (radiology, cardiology, surgery, and other).

RESULTS

The total number of DVT interventions increased over time, with 4.27 service counts per 100,000 beneficiaries in 2007 increasing to 13.4 by 2017, a growth rate of 12.09%. Radiologists performed the majority of interventions each year, except in 2013, in which they performed 46.6% of interventions, whereas surgeons and cardiologists combined performed the other 53.4%. In 2017, radiologists performed 7.56 services per 100,000 beneficiaries, which was 56.8% of the total count, more than those performed by surgeons, cardiologists, and unspecified providers combined.

CONCLUSIONS

Catheter-directed therapy is increasingly being used for the treatment of DVT, with its use undergoing a nearly 12-fold increase from 2007 to 2017 in the Medicare population. Radiologists remained the dominant provider of these services throughout the majority of study period, with a relative reduction in market share from 72% in 2007 to 57% in 2017.

Vascular and Interventional Radiology Training; International Perspectives and Challenges

PURPOSE

Assess international interventional radiology (IR) training standards and trainee satisfaction to identify challenges and drive positive change.

MATERIALS AND METHODS

An anonymous survey was created using Survey Monkey and distributed as a single-use web link via eight IR national and international societies around the world. It consisted of two parts: the first assessed the general exposure of radiology trainees to IR and whether this influenced their decision to pursue a career in IR; the second focussed on satisfaction and quality of training by those who are in training or have recently completed an IR training program.

RESULTS

There were 496 participants of which 274 were eligible to complete part one of the survey and 222 were eligible to complete the whole survey. UK and Europe contributed 52% of the responses. The USA and Middle East contributed 23%, and the rest of the world 9%. Over half of responders expressed that exposure early in their career was the main inspiration to pursue a career in IR. Overall satisfaction with training was high across all regions; however, satisfaction regarding vascular training varied. The negative impact of competition from other specialities ranged from 9% (USA) to 61% (UK). Great variability was reported regarding the amount of time spent dedicated to IR and IR on call.

CONCLUSION

Despite significant progress in creating structured and comprehensive IR training, there is still room for improvement. Early promotion of IR is essential for on-going high-quality recruitment. Monitoring and standardization of the training environment at a national and international level are necessary to equip IR trainees and to consolidate IR's speciality status in the medical field.

Diagnostic and Interventional Imaging Services are Significant Sources of Medicare Revenue for Highly Reimbursed Nonradiologist Providers

INTRODUCTION

Nonradiologist providers increasingly perform diagnostic imaging examinations and imaging-guided interventions traditionally performed by radiologists, which have raised concerns regarding appropriate utilization and self-referral. The purpose of this study was to assess the contribution of imaging studies to Medicare reimbursements for highly compensated nonradiologist providers in specialties often performing imaging studies.

METHODS

The Medicare Provider Utilization and Payment Database was queried for provider information regarding overall reimbursement for providers in anesthesiology, cardiology, emergency medicine, neurology, obstetrics and gynecology, orthopedic surgery, neurology, and vascular surgery. Information regarding imaging studies reported and payment amounts were extracted for the 25 highest-reimbursed providers. Data were analyzed for relative contribution of imaging payments to overall medical Medicare payments.

RESULTS

Significant differences between numbers of imaging studies, types of imaging, and payment amounts were noted based on provider specialty (p < 0.001). Highest-reimbursed cardiologists received the greatest percentage of Medicare payments from imaging (18.3%) followed by vascular surgery (11.6%), obstetrics and gynecology (10.9%), orthopedic surgery (9.6%), emergency medicine (8.7%), neurology (7.8%), and anesthesiology (3.2%) providers. Mean imaging payments amongst highly reimbursed nonradiologists were greatest for cardiology ($578,265), vascular surgery ($363,912), and orthopedic surgery ($113,634). Amongst highly reimbursed specialists, most common nonradiologist imaging payments were from ultrasound (45%) and cardiac nuclear medicine studies (40%).

CONCLUSIONS

Nonradiologist performed imaging payments comprised substantial proportions of overall Medicare reimbursement for highly reimbursed physicians in several specialties, especially cardiology, vascular surgery, and orthopedic surgery. Further investigation is needed to better understand the wider economic implications of nonradiologist imaging study performance and self-referral beyond the Medicare population.