can an interventional radiologist · r c o introduction • increasing numbers of imaging-assisted...
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UNIVERSITY OF WISC ONSIN–MADISONUNIVERSITY OF WISC ONSIN–MADISON
Can An Interventional Radiologist
Survive In Today’s Turf War?
John Swietlik, MD, Paul H Yi, MD, Nathan Kim,
MD & Jie Nguyen, MD, MS
Department of Diagnostic Radiology
University of Wisconsin-Madison
UNIVERSITY OF WISC ONSIN–MADISON
Disclosures
The authors have no financial disclosures
relevant to this electronic exhibit.
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Introduction• Increasing numbers of imaging-assisted endovascular and cardiac
procedures are being performed by non-Interventional Radiologists.
• This trend has raised concerns amongst Interventional Radiology (IR)
physicians regarding the financial viability of the field.
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“Between 1997 and 2002, procedure volume in percutaneous
peripheral arterial interventions grew at faster rates among
cardiologists, vascular surgeons, and other physicians than it did
among radiologists.”
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Let the Turf Wars Begin• As a result, there has been concern about turf wars between IR
and other endovascular and cardiac procedure-oriented fields
for decades.
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Goals & Objectives
• The purpose of this study was to assess the
differences in maximum Medicare reimbursements
to IR, VS, and Cardiology physicians.
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In other words…
Can the field of IR remain financially
viable in today's healthcare market?
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Methods
• The Medicare Provider Utilization and Payment Database
is a publicly available database provided by the Centers for
Medicare & Medicaid services (US Government
organization) that discloses all Medicare payments by
dollar amount to physicians from 2012 to the present.
• This database was queried for all IR, VS, and Cardiology
physicians who received Medicare reimbursements in
2014.
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Methods
• The top 50 physicians in each specialty queried who received
the most Medicare reimbursements in 2014 were searched for.
• Of these, the total Medicare reimbursements made to each
physician was tabulated.
• Average total Medicare reimbursements were compared
between the three specialties using T-tests and ANOVA
(significance set at p<0.05).
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Results
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No significant difference between the three specialties'
average total payments, although there were trends
toward significance (p=0.008).
Specialty Mean (USD) Min Max
Vascular Surgery $2,405,198 $1,453,301 $10,978,358
Cardiology $3,027,008 $1,911,600 $14,801,647
Interventional
Radiology$1,311,979 $965,738 $6,437,855
Average Total Medicare Reimbursements By Specialty
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Results
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• In further sub analysis, there was…
• No significant difference when comparing IR to Vascular Surgery
(p=0.20).
• However, there was a significant difference for IR compared to
Cardiology (p=0.003)!
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IR makes less… but there is hope!
• 50 highest-reimbursed IR physicians are paid less than their counterparts
• However, they are still able to maintain a high level of reimbursement relative to average salaries of US physicians.• Maximum Medicare reimbursement for IR was $6,437,855 and the
average of the top 50 was $1,311,979
• The average salary of an IR is $518,1641 compared to the average US physician salary of $294,0004.
• Our results suggest that it is possible for an IR physician to remain financially viable and successful even in the midst of turf wars.
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How can IR keep it’s turf?
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Interventions grew at faster rates among other subspecialists than it did among
radiologists, resulting in radiologists’ market share decline. However, total
procedure volume among radiologists continued to grow. Thus, despite the erosion,
interventional radiologists can still maintain a strong position in this rapidly growing
field.
“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”
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Limitations
• We did not assess the specific procedures that comprised
these reimbursements.
• This is an area for future study, both for specific procedures, # of
procedures, and reimbursements per procedure as a guide for how
to build a profitable practice or explain differences.
• This is a select group of physicians:
• May not be applicable to all in the specialties.
• However, does demonstrate the ‘upper limit’ or ‘ceiling’ for
reimbursements.
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Take-Home Points• Top Medicare earners in IR make less than Cardiology and
Vascular Surgery.
• However, IR can be reimbursed very highly compared to other
subspecialties.
• How these differences breakdown based on procedure #, type
and reimbursement/procedure are unclear and should be
studied in the future.
• Additionally, determining the practice patterns of these high
earners can serve as a model for future generations of IR to
remain financially viable in the current healthcare system.
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http://www.rsna.org/NewsDetail.aspx?id=14256
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Radiographs. American Journal of Roentgenology, 175(5), 1233-1238. doi:10.2214/ajr.175.5.1751233
4. Grisham, S. (2017, April 05). Medscape Physician Compensation Report 2017. Retrieved May 01, 2017, from
http://www.medscape.com/slideshow/compensation-2017-overview-6008547
5. Keller, E., Crowley-Matoka, M., Collins, J., Chrisman, H., Milad, M., & Vogelzang, R. (2017). Why vascular surgeons and interventional
radiologists collaborate or compete: A look at endovascular stent placements. Journal of Vascular and Interventional Radiology, 28(2).
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6. Levin, D. C., Rao, V. M., & Orrison, W. W. (2004). Turf wars in radiology: The quality of imaging facilities operated by nonradiologist physicians
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7. Levin, D. C., Rao, V. M., Parker, L., Bonn, J., Maitino, A. J., & Sunshine, J. H. (2005). The changing roles of radiologists, cardiologists, and
vascular surgeons in percutaneous peripheral arterial interventions during a recent five-year interval. Journal of the American College of
Radiology, 2(1), 39-42. doi:10.1016/j.jacr.2004.08.028
8. Mohan, C. (2016). Turf wars in radiology: Need for symbiotic relationships. Indian Journal of Radiology and Imaging, 26(4), 421. doi:10.4103/0971-
3026.195785
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Thank You!