Value Proposition in IO: Selling it to Hospitals and Oncologists

When talking to hospitals and oncologists about the benefits of having a full-time interventional radiology (IR) faculty, it is important to highlight the work related value units (wRVUs) that can be brought in from a clinical prospective, according to a presentation from Sarah White, MD, MS, FSIR at the Symposium on Clinical Interventional Oncology.

An issue when speaking with hospitals, is that they tend to view interventional radiologists as diagnostic radiologists, whom can make upward of $1,000 per hour. According to Dr. White, if a provider was placing 15 chest ports a day, at an approximate cost of $351 per port, they would only bring in $5,265 per day, which would not cover their salary in a hospital setting. Because of this, it is important to breakdown the value interventional radiologists can bring.

Dr. White is one of 8 full-time interventional radiologists fully integrated into a cancer center in Wisconsin. In her experience, when speaking with hospitals, clinical volume is crucial to the discussion. Her clinic brings in approximate 8,000 wRVUs from procedures and an additional 2,500 (wRVUs) per year from outpatient clinics.

Part of the reason they are able to achieve these numbers, Dr. White said, is because they have extensive personnel. At her clinic, the staff includes attending physicians, nurse practitioners, IR clinic nurses, patient coordinator, IR technologists, IR technologist interns, nurses, schedulers, assistants, trainees, research coordinator, practice manager, and billing specialists. When speaking with hospitals it is important to be able to defend the amount of personnel that is needed to be successful.

For example, Dr. White points out that when mid-level providers like nurse practitioners are utilized to perform procedures such as chest ports, tunneled lines, or peripherally inserted central catheters, they make more than enough money to cover their salaries and bring in revenue to the hospital. In addition, they free up time for the provider to do more complex procedures.

Providing basic procedures may not be enough to cover the salary of IR faculty, but these procedures do allow access to patients and oncologists.   

“If you think about those chest ports as a consult, the patient comes in and they have metastatic colorectal cancer and they are first line therapy you can introduce what interventional radiology does and by the time they are in the salvage setting, it may be they are coming back to you and coming for a Y90 radioembolization,” Dr. White said.

When it comes to basic procedures like placing chest ports, providers should emphasis that they can provide the service for significantly less money than when it is done in the operating room. A recent study1 found that when compared with an interventional radiologist, placing a chest port in the operating room is twice as expensive in part because of the anesthesia and all of the other components are charged to the hospital.

Dr. White also emphasized in her presentation that it was important for providers to let their work speak for themselves. She showed several images of poorly places ports done by surgeons and urged providers to “operate at the top of your license.”

Another large market that interventional radiologists can capitalize on in the hospital setting is palliative care services. Improving end of life is a major concern and will provide a large benefit for oncologists. Palliative care will not bring a large amount revenue but it will be a valuable service.

Alternative solutions that Dr. White suggests to help bring in money is for the hospital to pay for the service line or to have an office based (non-facility) setting for procedures.

Reference

LaRoy JR, White SB, Jayakrishnan T, et al. Cost and Morbidity Analysis of Chest Port Insertion: Interventional Radiology Suite Versus Operating Room. J Am Coll Radiol. 2015;12(6):563-71. doi: 10.1016/j.jacr.2015.01.012.