Individual radiologist specialization may best predict the complexity of interventional radiology (IR) procedures, according to findings published September 17 in the Journal of the American College of Radiology.
Both practice-level and radiologist-level IR specializations showed ties to greater procedural complexity, wrote a group led by Luke Wilkins, MD, from the University of Virginia in Charlottesville, and researchers from the Harvey L. Neiman Health Policy Institute in Reston, VA. The same trend went for greater provision of evaluation and management (E&M) services by both radiologists and nonphysician practitioners (NPPs).
“These findings suggest that the concentration of IR-related work at the physician level may be a key marker of the technical specialization and clinical engagement needed to deliver higher-complexity procedural care,” Wilkins and colleagues wrote.
Contemporary IR practice incorporates preprocedural consultation, periprocedural optimization, and postprocedural follow-up. These require E&M services within IR workflows.
Prior research suggests that interventional radiologists who provide more E&M services perform more complex procedures. However, the Wilkins team noted a lack of data that examines how these relationships take place at the practice level, where several factors come into play. These may include organizational structure, resource allocation, and staffing models that can influence clinical and procedural activity.
The researchers studied the association of E&M’s association with procedural complexity. This included evaluating the extent to which the radiologist and practice are focused on IR versus diagnostic radiology. The team mapped radiologists who provided care between 2008 and 2023 to Medicare fee-for-service beneficiaries (2008-2023) to practices. They also calculated the percentage of care the radiologists provided that was IR-related by using a 5% sample of beneficiary claims.
Final analysis included 29,844 practice-years. The researchers reported the following findings:
The proportional odds that a procedure had ≥5 work relative value units (wRVUs) was higher for practices billing >90% to 100% IR work compared with practices with >0% to 10% IR work.
The proportional odds for radiologists with a >90% to 100% IR share were higher compared with a >0% to 10% IR share (odds ratio, 74.7).
A wRVU increase of one in either radiologist or NPP E&M wRVUs per procedure was associated with 0.14 more wRVUs per procedure (p = 0.045 or p = 0.038, respectively).
The finding on NPP-provided E&M services supports “the potential importance of team-based care models in contemporary IR practice,” the study authors wrote.
“Although highly IR-focused practices may reflect environments capable of supporting higher complexity, the specific practice features responsible for building and sustaining high-volume, high-complexity IR programs were not directly tested in this analysis,” they added.
The authors called for future work to evaluate which parts of practice organization could enable radiologists to develop and maintain complex IR practices. These could include clinic infrastructure, referral pathways, staffing models, scheduling structures, and periprocedural support, they wrote.
Read the full study here.
