The Value of Clinical Interventional Radiology · The growing use of interventional radiology...
Transcript of The Value of Clinical Interventional Radiology · The growing use of interventional radiology...
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DEPARTMENT OF RADIOLOGY
Raymond Liu, MD, FSIRDepartment of RadiologyMassachusetts General Hospital
The Value of Clinical Interventional Radiology
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Agenda
• Clinical IR: A Journey• Revenue opportunity• MGH case study• Conclusions
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The growing use of interventional radiology techniques signals a need to redefine the radiologist’s role in
patient management…[we] must decide whether [we] want to participate more fully in clinical matters
such as patient selection and follow-up care.
“
Ernie Ring, 1983
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Introduction
• Interventional Radiology (IR) has been transitioning to an increasingly clinical delivery model in both outpatient and inpatient settings for years
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Introduction
• Interventional Radiology (IR) has been transitioning to an increasingly clinical delivery model in both outpatient and inpatient settings for years
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Clinical IR means focusing on the patient before and after the procedure
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Admitting and discharging patients becomes a skill necessary to learn
Discharge Process
Admission Guidelines
• Define admitting policy based on procedure mix and clinical training
• Develop consistent protocols• Arrange 24/7 coverage
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However, there is wide variation in clinical care models
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But very few IRs understand the financial impact of their clinical IR work
• Most radiology departments focus on procedural and exam based CPT codes to drive revenue and profit
• Conception that non-procedural activities redirect provider time from traditionally RVU-generating tasks– Especially pronounced when staff intentionally freed from
procedural duties
• With IR outpatient clinics and in patient rounding continue to evolve, reliable sense of revenue and profit is limited
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Traditional IR mindshare:Focused primarily on procedures
InpatientConsults
Procedures
Clinic / Rounds
OutpatientClinic
• Clinical care• Feed case pipeline• Enhance patient/referrer
perception of IR as clinical specialty
Inpatient Rounding
• Clinical care• New patients, follow-up care• Multi-touch interface with
clinical teams
Our Mindshare E&M Activities Benefits
• Clinical care• Feed case pipeline• Branding IR as true clinical
consult service
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“Best practice” clinical IR:What does it look like?
Inpatient Team Outpatient Team
Team
Patient population
Setting
Examples
+ + + +/-Attending APC(s) Trainee Attending APC(s) Trainee
• New consults for IR expertise• Pre- and post-procedural care on
IR or med/surg inpatient service
• New referrals, self-referrals to IR clinic
• Pre-procedural, follow-up, and longitudinal care for IR patients
• Inpatient floors (med/surg/ICU)• Emergency room• Observation units
• Stand-alone IR clinic, often near angio suites
• Co-located clinics (e.g. multidisciplinary HCC/onc)
• Consult for acute GI bleed, +/-angio, +/- follow up visits on ICU service
• s/p UAE for pain management on IR service
• HCC patient seen with team of hepatology, med-onc, transplant surg, IR
• Chronic venous insufficiency patient seen in IR clinic
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Inpatient rounding/consult team
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Co-located multidisciplinary clinic
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Maximizing advanced practitioner billing is critical
• Incident to billing– APs see established patients alone and bill under
supervising MD
• Independent billing– APs practice in collaborative environment, but MD
presence not required– AP is billing provider
• Shared visits– Both MD and AP perform significant portions of the visit
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Sparse literature nonetheless underscores opportunity
• Emory:– Duszak and Borst showed that Medicare IR claims
for nonprocedural clinical encounters increased by 1,200% from 1993-2008, with 1,112% growth attributed to inpatients
• MCoW:– White et al demonstrated that a structured
approach to increasing inpatient RVU capture resulted in 722% growth in charges and 831% growth in collected revenues over a 3 year period
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Agenda
• Clinical IR: A Journey• Revenue opportunity• MGH case study• Conclusions
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What is Evaluation & Management (E&M)?
• E&M forms basis of payments from all US payers• Requires direct, face-to-face physician-patient encounter• Coded with Current Procedural Terminology (CPT) codes that
are distinct from procedures• E&M codes reflect various features of clinical services
• Physician status (treating physician versus consultant)• Patient status (inpatient versus outpatient)• Service complexity• Time spent
• Governed by the global period
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However, finances have traditionally skewed in favor of procedures
ProceduralRevenue
E&M
Dollars ($)
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Goal: Expand E&M contribution to total IR revenues
ProceduralRevenue
E&M
Dollars ($)
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E&M growth does not occur in isolation
ProceduralRevenue
E&M
Dollars ($)
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“Halo” effect of E&M work expands practice
ProceduralRevenue
E&M
Dollars ($)
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Virtuous cycle feeds E&M, procedural revenue, and vice versa
Dollars ($)
ProceduralRevenue
E&M
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Our purpose
• Develop a financial modeling tool to assess potential revenues and profits generated from an outpatient interventional radiology (IR) clinic
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Our approach
• Model a baseline hypothetical IR clinic• Estimate current top-line revenuesStep 1:
Baseline Model
Step 2:Estimate Range of Possibilities
• Project range of potential revenues for IR practices of all different sizes
• Assess implications for daily practice as well as longer term division strategy
Step 2:Assess
Profitability
• Perform back of the envelope analysis to understand profitability of the enterprise
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Materials and Methods
Volume Mix PriceX X
Revenues
• How much do I sell
• What am I selling?
• How much am I charging?
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Revenue opportunities can be analyzed in both outpatient and inpatient settings
AverageCensus E&M Case Mix Staffing Mix Documentation Charges and
Collection Rate
Ass
umpt
ions
X X X X
• 8 existing patients per day
• 4 new patients per day
• New patients E&M mix (0% / 2% / 11% / 57% / 30%)
• Existing patients E&M mix (0% / 3% / 9% / 50% / 38%)
• APC solo visits and billing (0-5% of all visits)
• APC billing as % of attending physician (85%)
• Compliance with billing documentation by providers (95%)
• Estimated charges for new patients: $150-$650
• Estimated charges for existing patients: $75-$450
• Estimated gross collection rate: 30%
Formula and assumptions for calculating clinic $$ revenueVolume Mix PriceX X
Similar approach for inpatient practice
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Financial model mechanicsIRINPATIENTCLINICALMODEL Type: Source:ModelControl
ScenarioToggling CAUTIOUS 4 HitF-9tocalculate
AssumptionsGlobal
Workingdayspermonth 20 # N/ANumberofAdvancedPractitioners(AP) 3 # fact
%ofAPpatienttimebyNP 30% % Historicaldata;ExperienceNPbillingrateas%ofStaff 85% % CMS
%ofAPpatienttimebyPA 67% % calcPAbillingrateas%ofStaff 0% % CMS
Blendedbillinglevelas%ofstaffforAP 28% % calc
NewPatients#ofNewConsultsperDay 1 # Historicaldata;Experience
E&MDistributionLevel1 30% % HistoricaldataLevel2 60% % HistoricaldataLevel3 10% % HistoricaldataLevel4 0% % HistoricaldataLevel5 0% % Historicaldata
ProviderMixAPAlone 0% % Historicaldata;ExperienceAP+Staff 100% % calc
ProviderComplianceLevelwithDocumentationandProviderBilling(PatientKeeper)Level1 40% % Historicaldata;ExperienceLevel2 40% % feedLevel3 40% % feedLevel4 40% % feedLevel5 40% % feed
PercentageBillability2/2GlobalPeriodReductionLevel1 100% % MGHanalysis(ouranalysissuggestshighestvolume/revenuegeneratorsarealmostallnotaffectedbyglobalpreiodreduction)Level2 100% % feedLevel3 100% % feedLevel4 100% % feedLevel5 100% % feed
ChargesforReimbursementLevel1 $300 $ HistoricaldataLevel2 $500 $ HistoricaldataLevel3 $750 $ HistoricaldataLevel4 N/A $ HistoricaldataLevel5 N/A $ Historicaldata
GrossCollectionRate(GCR)Level1 19% % BillingteamLevel2 18% % BillingteamLevel3 15% % BillingteamLevel4 N/A % BillingteamLevel5 N/A % Billingteam
ExistingCasesAverageCensus/Day 30 # HistoricaldataAverage%Censusnotseen 0% % Experience
E&MdistributionSubsequentvisitlevel1 30% % HistoricaldataSubsequentvisitlevel2 40% % HistoricaldataSubsequentvisitlevel3 36% % Historicaldata
ProviderMixSubsequentvisitlevel1
APAlone 0% % HistoricaldataAP+Staff 100% % calc
Subsequentvisitlevel2APAlone 50% % HistoricaldataAP+Staff 50% % calc
Subsequentvisitlevel3APAlone 50% % HistoricaldataAP+Staff 50% % calc
ProviderComplianceLevelwithDocumentationandProviderBilling(PatientKeeper)Subsequentvisitlevel1 80% % feed(assumesamefornewconsults&existingcases)Subsequentvisitlevel2 80% % feedSubsequentvisitlevel3 80% % feed
PercentageBillability2/2GlobalPeriodReductionSubsequentvisitlevel1 100% % MGHanalysis(ouranalysissuggestshighestvolume/revenuegeneratorsarealmostallnotaffectedbyglobalpreiodreduction)Subsequentvisitlevel2 100% % feedSubsequentvisitlevel3 100% % feed
ChargesforReimbursementSubsequentvisitlevel1 $150 $ HistoricaldataSubsequentvisitlevel2 $300 $ HistoricaldataSubsequentvisitlevel3 $450 $ Historicaldata
GrossCollectionRate(GCR)Subsequentvisitlevel1 24% % HistoricaldataSubsequentvisitlevel2 14% % HistoricaldataSubsequentvisitlevel3 10% % Historicaldata
Calculations
CaseVolume&MixNewConsults
Totalnewconsultspermonth 20 # calcLevel1
#ofpatienttouchespermo 6 # calcAPalone 0 # calc
HIGH OPTIMISTIC BASE CAUTIOUS
HIGH OPTIMISTIC BASE CAUTIOUSGlobal 1 2 3 4
20 20 20 203 3 3 3
75% 45% 33% 30%85% 85% 85% 85%67% 67% 67% 67%0% 0% 0% 0%28% 28% 28% 28%
NewPatients4 3 2 1
0% 19% 19% 30%50% 74% 74% 60%50% 7% 7% 10%0% 0% 0% 0%0% 0% 0% 0%
0% 0% 0% 0%100% 100% 100% 100%
80% 60% 40% 40%80% 60% 40% 40%80% 60% 40% 40%80% 60% 40% 40%80% 60% 40% 40%
Increasing%ofpatientsseenbyNPs
ImprovingPKdocumentation
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Maximizing advanced practitioner billing is critical
• Incident to billing– APs see established patients alone and bill under
supervising MD
• Independent billing– APs practice in collaborative environment, but MD
presence not required– AP is billing provider
• Shared visits– Both MD and AP perform significant portions of the visit
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Documentation is key for the success of a clinical practice…
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…as well as understanding global periods
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Agenda
• Clinical IR: A Journey• Revenue opportunity• MGH case study• Conclusions
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An established clinical service with multiple components
• Inpatient service– 1 attending, 2-3 advanced practitioners, 1 fellow– 15-20 followup patients/day– 3-7 new consults/day
• Outpatient service– 5 days a week of outpatient clinic– Each attending has 1 day/week of dedicated outpatient
clinic– 5-10 patients/day
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Growth of both inpatient & outpatient volumesYear-over-year growth 124% (inpatient), 21% (outpatient)
Inpatient E&M Volume(2013-2016)
0123456789
101112
2013 2014 2015 2016
Inde
xed
Volu
me
(y1
= 1
.0)
Outpatient E&M Volume(2011-2014)
0.0
0.5
1.0
1.5
2.0
2011 2012 2013 2014(Annualized)
CAGR124%
CAGR21%
CAGR withoutOnc9%
Oncology
Follow Up
New Patients
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Commensurate growth in procedures…
1.0
1.5
2.0
2010 2011 2012 2013 2014 2015 2016
Total IR Case Volume Case Volume (2010-2016)
CAGR6%
(Annualized)
Inde
xed
Volu
me
(y1
= 1
.0)
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1.0
1.5
2.0
2.5
2011 2012 2013 2014 2015
…especially in interventional oncology
Total IO Case Volume Case Volume (2011-2015)
CAGR19%
Inde
xed
Volu
me
(y1
= 1
.0)
Outpatient E&M Volume
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Results
Estimated Total Annual Charges Estimated Total Annual Revenues
Existing Patients
New Patients Existing Patients
New Patients0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
$992K
$298K
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Our model suggests a broad range of annual revenues from outpatient E&M…
Practice Type: Small Moderate Large Mega
Clinic Days/Week 0.5 2.0 4.0 5.0
Number MDs (FTE) 0.125 0.25 0.50 1.00
Number APCs (FTE) 0.25 0.50 1.00 1.50
New Consults/Day 1 2 4 7
Existing Consults/Day 2 5 8 15
Estimated annual charges $30,999 $284,298 $991,961 $2,260,683
Estimated annual collected revenues $9,300 $85,289 $297,588 $678,205
Scientific Talk, SIR 2016
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…as well as inpatient E&M
Practice Type: Small Moderate Large Mega
Full Billing Days/Week 5 5 5 5
Number MDs (FTE) Variable
Number APCs (FTE) 0.5 1.0 2.0 4.0
New Consults/Day 0.2 0.5 2 3
Existing Consults/Day 5 10 35 50
Estimated annual charges $319,579 $643,761 $2,264,672 $3,241,822
Estimated annual collected revenues $54,766 $110,574 $389,612 $558,075
JVIR 2016
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But what about PROFITS?
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Materials and Methods
Revenues Costs Profit/Loss- =
• E&M Capture• Downstream
imaging• Procedures
• Salary & benefits• Rent & facilities• Overhead (SG&A)
• Did we make money or lose money?
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Materials and Methods
Revenues Costs Profit/Loss=DownstreamImaging+ -
• Radiology practices likely benefit from the need for imaging in IR patients
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ResultsD
olla
rs ($
)
Revenues Costs Profit/(Loss)
DownstreamImaging
TrueProfit
$298K ($396K)
($98K)
~$098K
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Sensitivity analysis
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Agenda
• Clinical IR: A Journey• Revenue opportunity• MGH case study• Conclusions
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Conclusions
• The field of IR has largely successfully transitioned to a “clinical” specialty
• Yet the true financial impact on IR practices is still in its infancy
• There are challenges– Close relationship with finance/billing– Thoughtful deployment of IR FTE resources– Downstream imaging revenue analysis needs to be
incorporated– Significant cultural shift, requires commitment of all team
members
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Acknowledgements
• Jim Brink, MD• Peter Mueller, MD• Alex Misono, MD• Kevin Pian, MBA• Adam Harbaugh• Rob Sheridan
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Thank you
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References• Andrews RT. The financial “halo effect” of an interventional radiology clinic. Paper presented at: Society of Interventional Radiology 32nd Annual Scientific
Meeting; Seattle, Wash; March 1-6, 2007• ACR Radiology Coding Source: Evaluation and Management Services in Interventional Radiology (http://www.acr.org/Advocacy/Economics-Health-
Policy/Billing-Coding/Coding-Source-List/2008/Jan-Feb-2008/Evaluation-and-Management-Services-in-Interventional-Radiology)• ACR. Practice guideline for interventional clinical practice. Reston, Va: American College of Radiology; 2009. ACR–SIR–SNIS–SPR PRACTICE
PARAMETER FOR INTERVENTIONAL CLINICAL PRACTICE AND MANAGEMENT (https://www.acr.org/~/media/0c8928b2a2ee42acb640083c7d3def2f.pdf)
• Brunner MC, Durham JD, Lewis CA, McClenny TE. Strategic initiatives in interventional radiology: the clinical imperative. J Vasc Interv Radiol 2003;14:1099-101.
• Chittle MD, Vanderboom T, Borsody-Lotti J, Ganguli S, Hanley P, Martino J, Mueller P, Penzias A, Saltalamacchia C, Sheridan RM, Hirsch JA. An overview of clinical associate roles in the neurointerventional specialty. J Neurointerv Surg. Epub 2015 Jan 5.
• Dhand S, Rajeswan S, Chrisman H, et al. The economic impact of an interventional radiology clinic on a diagnostic radiology department. Paper presented at: Society of Interventional Radiology 32nd Annual Scientific Meeting; Seattle, Wash; March 1-6, 2007.
• Duszak R Jr. Money and Reputation: Squandered Opportunities of a Clinical IR Service. J Vasc Interv Radiol. 2015 Jul;26(7):963-4.• Duszak R Jr, Borst RF. Clinical services by interventional radiologists: perspectives from Medicare claims over 15 years. J Am Coll Radiol. 2010
Dec;7(12):931-6.• Funaki B. Top 5 reasons why you canʼt blame interventional radiologists for neglecting clinical duties for so long. Semin Intervent Radiol. 2006;23:303–304. • Hirsch JA1, Leslie-Mazwi TM, Barr RM, McGinty G, Nicola GN, Silva E 3rd, Manchikanti L. The Bundled Payments for Care Improvement Initiative. J
Neurointerv Surg. Epub 2015 Mar 31.• Katzen BT, Kaplan JO, Dake MD. Developing an interventional radiology practice in a community hospital: the interventional radiologist as an equal partner in
patient care. Radiology 1989;170:955-8.• Kwan SW, Valji K. Interventional radiologists' involvement in evaluation and management services and association with practice characteristics. J Vasc Interv
Radiol. 2012 Jul;23(7):887-92.• Levin DC, Rao VM, Bree RL, Neiman HL. Turf battles in radiology: how individual radiologists can respond to the challenge. Radiology 1998;209: 330-4.• Levin DC, Rao VM, Bonn J. Turf wars in radiology: the battle for peripheral vascular interventions. J Am Coll Radiol 2005;2:68-71.• Meehan TM, Harvey HB, Duszak R Jr, Meyers PM, McGinty G, Nicola GN, Hirsch JA. Accountable Care Organizations: what they mean for the country and
for neurointerventionalists. J Neurointerv Surg. Epub 2015 May 18.• Murphy TP. Interventional radiology: a call to arms. J Vasc Interv Radiol 1999;10:377-8.• Soares GM. The value of clinical interventional radiology. J Am Coll Radiol. 2011 May;8(5):318-24• White SB, Dybul SL, Patel PJ, Hohenwalter EJ, Hieb RA, Shah SP, Rilling WS, Tutton SM. A Single-Center Experience in Capturing Inpatient Evaluation and
Management for an IR Practice. J Vasc Interv Radiol. 2015 Jul;26(7):958-62.