Clinical services in interventional radiology: results from the national Medicare database and a Society of Interventional Radiology membership survey

A Claims-Based Method for Identification and Characterization of Practicing Interventional Radiologists

PURPOSE

To propose a research method for identifying "practicing interventional radiologists" using 2 national claims data sets.

MATERIALS AND METHODS

The 2015-2019 100% Medicare Part B data and 2015-2019 private insurance claims from Optum's Clinformatics Data Mart (CDM) database were used to rank-order radiologists' interventional radiology (IR)-related work as a percentage of total billed work relative value units (RVUs). Characteristics were analyzed at various threshold percentages. External validation used Medicare self-designated specialty with Society of Interventional Radiology (SIR) membership records; Youden index evaluated sensitivity and specificity. Multivariate logistic regression assessed practicing IR characteristics.

RESULTS

In the Medicare data, above a 10% IR-related work threshold, only 23.8% of selected practicing interventional radiologists were designated as interventional radiologists; above 50% and 90% thresholds, this percentage increased to 42.0% and 47.5%, respectively. The mean percentage of IR-related work among practicing interventional radiologists was 45%, 84%, and 96% of total work RVUs for the 10%, 50%, and 90% thresholds, respectively. At these thresholds, the CDM practicing interventional radiologists included 21.2%, 35.2%, and 38.4% designated interventional radiologists, and evaluation and management services comprised relatively more total work RVUs. Practicing interventional radiologists were more likely to be males, metropolitan, and earlier in their careers than other radiologists at all thresholds.

CONCLUSIONS

Most radiologists performing IR-related work are designated in claims data as diagnostic radiologists, indicating insufficiency of specialty designation for IR identification. The proposed method to identify practicing interventional radiologists by percent IR-related work effort could improve generalizability and comparability across claims-based IR studies.

Professional Services Rendered by Nurse Practitioners and Physician Assistants Employed by Radiology Practices: Characteristics and Trends From 2017 Through 2019

PURPOSE

With radiology practices increasingly employing nonphysician practitioners (NPPs), we aimed to characterize specific NPP clinical roles.

METHODS

Linking 2017 to 2019 Medicare data sets, we identified all claims-submitting nurse practitioners and physician assistants (together NPPs) employed by radiologists. NPP-billed services were identified, weighted by work relative value units, and categorized as (1) clinical evaluation and management (E&M), (2) invasive procedures, and (3) noninvasive imaging interpretation. NPP practice patterns were assessed temporally and using frequency analysis.

RESULTS

As the number of radiologist-employed NPPs submitting claims increased 16.3% (from 523 in 2017 to 608 in 2019), their aggregate Medicare fee-for-service work relative value units increased 17.3% (+40.0% for E&M [from 79,540 to 111,337]; +5.6% for procedures [from 179,044 to 189,003]; and +74.0% for imaging [from 5,087 to 8,850]). The number performing E&M, invasive procedures, and imaging interpretation increased 7.6% (from 329 to 354), 18.3% (from 387 to 458), and 31.8% (from 85 to 112), with 58.2%, 75.3%, and 18.4% billing those services in 2019. Paracentesis and thoracentesis were the most frequently billed invasive procedures. Fluoroscopic swallowing and bone densitometry examinations were the most frequently billed imaging services. By region, NPPs practicing as majority clinical E&M providers were most common in the Midwest (33.5%) and South (33.0%), majority proceduralists in the South (53.1%), and majority image interpreters in the Midwest (50.0%).

CONCLUSIONS

As radiology practices employ more NPPs, radiologist-employed NPPs' aggregate services have increased for E&M, invasive procedures, and imaging interpretation. Most radiologist-employed NPPs perform invasive procedures and E&M. Although performed by a small minority, imaging interpretation has shown the largest relative service growth.

Four types of tumor progression after microwave ablation of single hepatocellular carcinoma of ≤5 cm: incidence, risk factors and clinical significance

OBJECTIVES

To evaluate the incidence, risk factors and clinical significance of four types of tumor progression (TP) after microwave ablation (MWA) of single hepatocellular carcinoma (HCC) of <5 cm.

METHODS

The data of 340 treatment-naïve, HCC patients with a single HCC of <5 cm underwent MWA between April 2012 and November 2017 were retrospectively reviewed. TPs including local tumor progression (LTP), intrahepatic distant recurrence (IDR), aggressive intrasegmental recurrence (AIR) and extrahepatic distant recurrence (EDR) were reviewed and compared between BCLC stage 0 and A. Univariate and multivariate analysis were performed on clinicopathological variables and different TPs to identify factors affecting long-term overall survival (OS).

RESULTS

In a median follow-up period of 25.6 months (range, 3.1-61.4 months), the rate of LTP, IDR, AIR and EDR was 6.2% (21/340), 29.1% (98/340), 3.2% (11/340) and 7.9% (27/340). The four types of TP occurrence rates in BCLC stage 0 were comparable to those in BCLC stage A (p = 0.492, 0.971, 0.681 and 0.219). Univariate analysis showed that age (p < 0.001, hazard ratio [HR] = 2.783), comorbidities (p = 0.042, HR = 1.864), IDR, AIR and EDR (p = 0.027, HR = 1.719; p = 0.001, HR = 3.628; p = 0.009, HR = 2.638) were independently associated with OS. Multivariate analysis showed older age (p < 0.001, HR = 2.478), the occurrence of AIR (p < 0.001, HR = 2.648) and the occurrence of EDR (p = 0.002, HR = 2.222), were associated with poor OS.

CONCLUSIONS

The occurrence rate of IDR is the highest of all TPs following MWA of a single HCC of <5cm. Old age, AIR and EDR had an adverse effect on long-term OS.

Measuring work complexity for acute care services

Case weights capture the resource cost by diagnosis-related group (DRG) but may not fully reflect the complexity of the clinical services provided. This study describes the use of a work complexity index (WCI), for assessing acute care services focusing on those provided by physicians in healthcare systems. The services are classified using relative value units (RVUs) and their point value assigned using the resource-based relative value scale. 57,559 acute inpatients from a tertiary hospital were first classified into diagnosis-related groups, which together with the relative value units assigned to services were then used to calculate a work complexity index for 38 departments. A case mix index (CMI) was also compiled as a conventional measure of complexity which had a correlation of 0.676 (p < 0.001) with the WCI. The correlation between the WCI and the RVUs representing the weighted volume of physician activities was 0.342 (p = 0.036). The WCI represents a more output or activity focused measure of complexity whereas the CMI is more patient focused and thus provides better insights into Departments' productivity. Although this paper focuses on physicians, the WCI can be easily extended to include other clinical services.

Computed tomography-guided radiofrequency ablation combined with transarterial embolization assisted by a three-dimensional visualization ablation planning system for hepatocellular carcinoma in challenging locations: a preliminary study

OBJECTIVE

To assess the clinical efficacy and safety of computed tomography-guided radiofrequency ablation(CT-RFA) combined with transarterial embolization(TAE) assisted by a three-dimensional visualization ablation planning system(3DVAPS) for hepatocellular carcinoma(HCC) in challenging locations.

METHODS

Data from 62 treatment-naive patients with hepatocellular carcinoma(HCC), with 83 lesions in challenging locations, and who met the Milan criteria and underwent CT-RFA between June 2013 and June 2016 were reviewed. Patients were divided into one of two groups according to different treatment modalities: study group (TAE combined with RFA assisted by 3DVAPS [n = 32]); and control (RFA only [n = 30]). Oncological outcomes included ablation-related complications, local tumor progression (LTP), and overall survival (OS). Univariate and multivariate Cox proportional hazards regression analyses were performed to assess risk factors associated with LTP and OS.

RESULTS

HCC lesions (mean size, 1.9 ± 1.0 mm in diameter) abutting the gastrointestinal tract (n = 25), heart and diaphragm (n = 21), major vessels (n = 13), and gallbladder (n = 3) were treated. A significant difference was detected in LTP between the two groups (P = 0.034), with no significant difference in OS between the two groups (P = 0.193). There were no severe complications related to ablation. Univariate analysis revealed that sex (P = 0.046) and child-turcotte-pugh (CTP) grade (P<0.001) were risk factors for OS, whereas CTP grade and treatment method (P<0.001) were risk factors for LTP. Multivariate analysis revealed that CTP grade B (P = 0.005) was independently associated with poor OS, and RFA alone (P<0.001) was independently associated with poor LTP.

CONCLUSION

CT-RFA combined with TAE assisted by a 3DVAPS provided ideal clinical efficiency for HCC in challenging locations and was a highly safe treatment modality.

3D visualization ablation planning system assisted microwave ablation for hepatocellular carcinoma (Diameter >3): a precise clinical application

Background

The aim of this retrospective study was to compare the feasibility and efficiency of ultrasound-guided percutaneous microwave ablation (US-PMWA) assisted by three-dimensional visualization ablation planning system (3DVAPS) and conventional 2D planning for hepatocellular carcinoma (HCC) (diameter > 3 cm).

Methods

One hundred thirty patients with 223 HCC nodules (5.0 ± 1.5 cm in diameter, [3.0–10.0 cm]) who met the eligibility criteria divided into 3D and 2D planning group were reviewed from April 2015 to August 2018. Ablation parameters and oncological outcomes were compared, including overall survival (OS), recurrence-free survival (RFS), and local tumor progression (LTP). Multivariate analysis was performed on clinicopathological variables to identify the risk factors for OS and LTP.

Results

The median follow-up period was 21 months (range 3–44). Insertion number (5.4 ± 1.2 VS. 4.5 ± 0.9, P = 0.034), ablation time (1249.2 ± 654.2 s VS. 1082.4 ± 584.7 s, P = 0.048), ablation energy (57,000 ± 11,892 J VS. 42,600 ± 10,271 J, P = 0.038) and success rate of first ablation (95.0% VS. 85.7%, P = 0.033) were higher in the 3D planning group compared with those in 2D planning group. There was no statistical difference in OS, and RFS between the two groups (P = 0.995, P = 0.845). LTP rate of 3D planning group was less than that of 2D planning group (16.5% VS 41.2%, P = 0.003). Multivariate analysis showed tumor maximal diameters (P < 0.001), tumor number (P = 0.003) and preoperative TACE (P < 0.001) were predictors for OS and sessions (P = 0.024), a-fetoprotein level (P = 0.004), and preoperative planning (P = 0.002) were predictors for LTP, respectively.

Conclusions

3DVAPS improves precision of US guided ablation resulting in lower LTP and higher 5 mm-AM for patients with HCC lesions larger than 3 cm in diameter.

Advanced Practice Professionals and an Outpatient Clinic: Improving Longitudinal Care in an Interventional Radiology Practice

The field of interventional radiology (IR) has made tremendous advances in both scope and practice since its inception in the early 1960s. With these advances, it has solidified itself as a valuable subspecialty to the medical community and, most importantly, to the patients who receive IR care. Expanding clinical services to improve care in both the pre- and postprocedural setting is a logical step in IR maturation. The use of advanced practice professionals, in the form of physician assistants and nurse practitioners, can add value in both quality of the patient experience and exposure to other subspecialties. Furthermore, a dedicated outpatient clinic provides a centralized site to evaluate patients and communicate with referring services. These additions can be a challenging value proposition, particularly when working in a combined diagnostic radiology and IR practice, but given the benefits, these are well worth the time and monetary investments.

Current Clinical Practice Patterns of Self-Identified Nuclear Medicine Specialists

OBJECTIVE

The objective of our study was to study patterns of services rendered by U.S. physicians who self-identify as nuclear medicine (NM) specialists.

MATERIALS AND METHODS

Recent Medicare physician claims and demographic files were obtained and linked. NM specialists were defined as physicians self-identifying NM as their primary specialty on claims or as any of their specialties during enrollment. Using other self-identified specialties, we classified physicians as nuclear radiologists, nuclear cardiologists, exclusively NM physicians, or Others. Our primary outcome measure was the percentage of NM effort (in work relative value units [WRVUs]) per physician per specialty group. Secondary outcome measures included physician sociodemographic parameters and most common uniquely rendered services.

RESULTS

Nationally, 1583 physicians self-identified as NM specialists during the calendar years 2012 through 2015. The distribution of WRVUs attributed to NM varied widely by specialty group; most nuclear radiologists and nuclear cardiologists devoted 10% or less of their effort to NM services whereas most NM physicians devoted 90% or more of their effort to NM services. NM specialists were most commonly nuclear radiologists (52.2%) and men (80.3%) and practiced in urban (98.4%) and nonacademic settings (62.9%). NM physicians interpreted more general NM studies, nuclear radiologists interpreted more cross-sectional imaging studies, and nuclear cardiologists interpreted mostly nuclear cardiology studies, with a majority of their overall work attributed to clinical evaluation and management (E/M). E/M services accounted for less than 2% of WRVUs for both nuclear radiologists and NM physicians.

CONCLUSION

The work patterns of U.S. NM specialists is highly variable. Most NM physicians practice 90% or more NM, whereas most nuclear radiologists and nuclear cardiologists practice 10% or less NM. Commonly performed services vary considerably by specialty group.

Tracking changes in the practice of interventional radiology

The Society of Interventional Radiology survey in 2000 to 2001 reported what appeared to be favorable results. However, closer scrutiny provides more information. The Society of Interventional Radiology's strategic plan calls for 80% of interventional radiologists to be clinical practitioners by the year 2006. Recent American College of Radiology practice guidelines support this goal. Interventionalists need to decide whether they are going to provide clinical care and those who chose to take on the clinical practice model will most likely be successful.

Malpractice issues in radiology: medicare compliance versus standard of care conformance--real or imaginary conflict?

Plaintiff's Attorney (Pl Att:: Doctor, the record shows that the patient was referred to the hospital's radiology department by her gynecologist for a screening mammogram. The record also shows that when completing the mammography information form, the patient wrote that she had a lump in her left breast, correct? Defendant Radiologist (Df Ra:): Yes. Pl Att: But your technologist performed, and you interpreted, a screening mammogram. Doesn't the radiology standard of care require you to do a diagnostic mammogram when the patient has a breast lump? Df Ra:: Well, normally yes, but if it's going to be a diagnostic mammogram, then the referring physician has to order it. In this case our tech called the gynecologist and asked him whether he wanted to order a diagnostic study, and he said no, he didn't feel the lump, and that we should only do a plain screening mammogram. Pl Att:: Please explain something. You're agreeing that a woman with a breast lump should have a diagnostic mammogram, but you are saying that you didn't do one because the patient's physician wouldn't order it? Don't you have a duty to do the diagnostic mammogram in a case like this on your own, without having to ask permission from the patient's gynecologist? Df Ra:: Only the treating physician can change a screening mammogram into a diagnostic mammogram, and I am not the treating physician. If I went ahead and did a diagnostic mammography examination on my own, it would be Medicare fraud, and our hospital's compliance officer says it could result in our hospital being fined and thrown out of the Medicare program. Pl Atty: What prevents you then from recommending-not ordering, but just recommending-a diagnostic mammogram in your report, because the patient says she's got a lump? Df Rad: Well, according to our hospital's compliance officer, that would also be fraud.

CPT coding by interventional radiologists: a multi-institutional evaluation of accuracy and its economic implications

PURPOSE

To evaluate the accuracy of Current Procedural Terminology (CPT) coding for interventional radiology procedures and the associated professional economic impact when coding is performed by operating physicians.

METHODS

Procedure reports and physician charge sheets were obtained for 549 interventional radiology encounters performed by 62 physicians at 23 hospitals and analyzed for appropriate CPT code use. Physician-selected CPT codes were reviewed by experts, who determined correct coding by consensus. Physician coding errors and professional relative value unit (RVU) impact were analyzed. Expert discordance and associated RVU impact were similarly evaluated.

RESULTS

Physicians correctly coded only 242 of 549 IR cases (44%). The overall professional RVU impact of their errors was +4.2% (overcoding). Physician coding was correct least frequently for complex arterial interventions (15 of 53, 28%) and dialysis access interventions (16 of 54, 30%) and correct most frequently for less code-intensive drainage (19 of 31, 61%) and biopsy procedures (35 of 47, 74%). Experts were initially concordant in 497 of 549 cases (91%), with only a minimal tendency (+0.3% RVU) toward overcoding. Expert coding differences were explained by simple code oversights (28 of 52, 54%), coding guideline ambiguity (15 of 52, 29%), and physician documentation ambiguity (9 of 52, 17%).

CONCLUSION

When interventionalists code their own procedures, CPT errors are common, but the associated RVU impact is small. Given the consequences of incorrect coding, physician-assigned CPT codes warrant review by experienced coders before claims submission. Although radiology practices should strive for perfect coding, expert discordance suggests that this goal is unattainable but less elusive than for nonradiology services.

Turf wars in radiology: the battle for peripheral vascular interventions

Interventional radiologists in many hospitals are involved in confrontations with cardiologists and vascular surgeons over who should be allowed to perform percutaneous noncardiac peripheral vascular interventions. There are valid reasons why radiologists should be the ones doing these procedures: first, because in any given hospital, radiologists are generally the physicians with the best training and most experience, and second, because they are generally not in a position to self-refer and will therefore be able to help keep utilization under control. If cardiologists or vascular surgeons request vascular interventional privileges at your hospital, there are steps you can take to see if they are properly qualified. If they are granted privileges, there are other steps you can take to ensure that high standards of patient care are maintained. The authors also present some discussion of how interventional radiologists can position themselves to either compete with or collaborate with the other clinical services. Throughout any confrontations that might occur, radiologists should stress that patients undergoing these procedures deserve the best possible care, which means that they should be performed by those physicians on the hospital staff who are the most knowledgeable and the least likely to commit medical errors.

The Pediatric Hospitalist and Interventional Radiologist: A Model for Clinical Care in Pediatric Interventional Radiology

Interventional radiology serves an important role in the diagnostic and therapeutic management of the pediatric patient in a tertiary pediatric hospital. On many levels, it is important for the interventional radiologist to be involved in patient care outside the procedure room. However, lack of clinical training, time, and resources may impair this transition. This article describes a unique collaboration between the interventional radiologist and the pediatric hospitalist in a tertiary-care pediatric center, which fosters the clinical role of the interventional radiologist while providing the best care for children undergoing interventional procedures.

Clinical Services Provided by Interventional Radiologists to Medicare Beneficiaries in the United States, 2000-2003

To identify trends in Evaluation and Management (E&M) and non-E&M services of interventional radiologists (physician specialty type 94) from 2000 to 2003 for Medicare patients, Medicare Part B physician annual allowed services data from the Centers of Medicare and Medicaid Services (CMS) were analyzed for all interventional radiologists from 2000 to 2003. Because the number of interventional radiologists in the United States according to the Society of Interventional Radiology is, on average, 4.2 times the number of interventional radiologists who use physician specialty type 94, we extrapolated the E&M services for each year. During the period examined, the total number of E&M services by interventional radiologists increased 309%, from 9,698 in 2000 to 29,914 in 2003. The most commonly performed services were Office or Other Outpatient Visit (Current Procedural Terminology [CPT] codes 99211-99215) for established patients, followed by Subsequent Hospital Care (CPT 99231-99233) and Office or Other Outpatient Consultations (CPT 99241-99245). The extrapolated number of E&M services by interventional radiologists for Medicare patients in 2003 is approximately 107,853. The number of Office and Outpatient Visits for New Patients (CPT 99201-99205) increased 142%, whereas the number of Consultations for New Patients (CPT 99241-99245) increased 208%. The total number of codes reimbursed by CMS to interventional radiologists (type 94) increased from 2.8 million in 2000 to 3.8 million in 2003.

Attitudes of and Influences on Residents in English Canadian Radiology Programs Regarding Interventional Radiology: Results of a National Survey by the Canadian Interventional Radiology Association (CIRA)

PURPOSE

There has been a North American trend toward reduced application to the subspecialty of Interventional Radiology (IR). Out of fear of a looming manpower shortage, this survey was conducted to better understand awareness and attitudes toward IR by radiology residents-in-training.

MATERIALS AND METHODS

An anonymous online survey was emailed to the Diagnostic Radiology Residency Program Director/Department Chairperson of each of the 13 English medical schools in Canada, to be forwarded to each respective Radiology Residency Program's radiology residents. The survey was open for a period of 1 month. The survey consisted of 29 questions, which could be answered online using a web-based program. Responses to questions were tabulated and comments recorded.

RESULTS

A total of 84 survey responses were received of a possible 333 (25%), including responses from each of the 13 English Programs. Responses regarding demographics, training, careers aspirations and motivations, and influences were collected. Fifty-one percent of respondents reported being either "moderately" or "very" interested in the field of IR; however, only 13% reported intention to perform an IR fellowship. A number of issues were identified as dissuading current radiology residents from pursuing IR, including income, work hours and hours of on-call, and turf issues.

CONCLUSION

A number of issues were identified as factors which prevented residents with an interest in IR from applying to IR fellowships. These must be addressed to increase IR recruitment rates of radiology residents.

The interventional radiology clinic: what you need to know

It is increasingly recognized that clinical management in interventional radiology is necessary. To effectively participate in such management requires patient management infrastructure. The cornerstone of this effort is the clinical office.

The interventional radiology clinic: key ingredients for success

During the past two decades, the practice of interventional radiology has evolved into one that mandates longitudinal patient care taking place before, during, and after interventional procedures. This requires the establishment of relationships between physicians and patients that often must be fostered in an outpatient clinic setting. Recognition of this practice shift was formally made by the American College of Radiology with the publication of a document concerning the importance of clinical patient management within the practice of interventional radiology. This article will review the clinical patient management as it relates to the practice of interventional radiology, with a focus on the physician-patient relationship and the components of a successful outpatient clinic.

Reimbursement risks with radiologist extenders: there is no free lunch!

There is great allure in the concept of using qualified health care providers to assist radiologists and radiation oncologists, increasing efficiency and possibly even improving patient care delivery. However, physician services are most commonly reimbursed under a system that is resource based, and the physician work and practice expense components of reimbursement for existing procedure codes are periodically reexamined to ensure their appropriate rank in this "relative value system." Also, as new codes are developed, demonstrable physician work and practice expenses will determine the relative values for the new procedures. In both cases, the type of individual who actually performs different portions of a procedure will determine the reimbursement level. In addition, the total reimbursement must be appropriately apportioned between the physician involved and the facility where the service is delivered. This article examines some of the potential impacts on procedure coding and radiologist and radiation oncologist reimbursement schedules if physician extenders perform work previously performed by physicians. It also examines possible shifts in reimbursement from physician to facility if an extender is employed by a facility.

National trends in gastrointestinal access procedures: an analysis of Medicare services provided by radiologists and other specialists

PURPOSE

To evaluate national trends in enteral access services by radiologists and other specialists.

MATERIALS AND METHODS

Medicare data from 1997 to 2000 were analyzed for trends in gastrointestinal access services. Current Procedural Terminology codes for gastrostomy placement and maintenance services were selected. Utilization was analyzed by physician specialty. Targeted service analysis was performed for interventional radiologists.

RESULTS

For sampled enteral access procedures, annual services to Medicare beneficiaries increased from 279,509 to 283,353 (+1.4%). These were most often performed by gastroenterologists (48.6%), surgeons (25.1%), radiologists (7.4%), and others (18.9%). Total procedures by radiologists increased 29.6% whereas procedures by gastroenterologists, surgeons, and other nonradiologists changed +6.9%, -4.9%, and -10.2%, respectively. For new gastrostomy accesses, radiologist volume increased 46.9% whereas gastroenterologist, surgeon, and other volumes changed +7.9%, -5.0%, and -21.5%, respectively. For maintenance services, radiologist volume increased 21.8% whereas gastroenterologist, surgeon, and other volumes changed +3.1%, -4.7%, and +7.9%, respectively. Analyzed for frequency, relative value, and physician time, enteral access services account for less than 1% of all services provided by interventional radiologists.

CONCLUSIONS

Although the number of gastrointestinal access services provided to Medicare beneficiaries has remained static, radiologists have experienced a marked relative increase in volume, particularly for new gastrostomy procedures. This increase is largely at the expense of surgeons and other nongastroenterologists. However, radiologists still provide only a small portion of gastrointestinal access services nationwide, and these services account for only a small portion of all procedures performed by interventionalists. Therefore, the potential for enteral access service growth in interventional radiology is high.

Percutaneous abscess drainage: use of related radiology services and associated economic impact on a radiology practice

PURPOSE

To evaluate the impact of percutaneous abscess drainage on the usage and professional value of subsequent services provided by a radiology practice.

MATERIALS AND METHODS

Percutaneous abscess drainage was selected as a marker interventional radiology procedure because of its pervasiveness and ease of identification of related services. Billing records were reviewed for 48 consecutive patients who underwent abscess drainage during a 9-month period. Current procedural terminology (CPT) codes for all radiology services during the subsequent 90 days were analyzed to identify those related to the initial drainage procedure. Professional relative value unit (RVU) impact was calculated.

RESULTS

Initial abscess drainage services were identified by 2.6 +/- 1.2 CPT codes, but patients underwent 13.4 +/- 10.7 related radiology services during the subsequent 90 days. The professional RVU impact of subsequent services was 64% higher than that of initial procedures: initial drainage services accounted for 11.5 +/- 5.1 RVUs and all subsequent related radiology services accounted for 18.9 +/- 16.8 RVUs (P =.0042). Of those, additional interventional radiology procedures amounted to 10.7 +/- 12.8 RVUs, diagnostic radiology services 4.7 +/- 4.6 RVUs, and evaluation and management services 3.5 +/- 2.9 RVUs.

CONCLUSION

Basic interventional radiology services may result in far more economic impact on radiology practices than initial direct procedure analyses suggest. For percutaneous abscess drainage, the professional RVU impact of subsequent services exceeds that of the initial procedure by 64%. Practices negotiating capitated contracts for interventional services need to consider the high value of such related services.