Enough of the DRA and it vale of gloom. Consider this: From the demographic perspective, the boomers will not have their anticipated effect on the need for hospital beds or health spending, according to a recent report published online by Health Affairs. Although the authors believe that aging will have an impact on spending, its effect will be mitigated by the impact of advances in technology and other factors that affect medical practice patterns. They cited the example of coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty. Between 1993 and 2002, if nothing had changed other than the age distribution of the population, use of each of these procedures would have increased 0.6% per year. Actual rates of growth for PTCA during an inpatient stay was 83.4%, or 7% per year, from 1993 to 2002; growth rate for CABG was 1.4%, or 0.2%.

Between 1963 and 1987, spending on hospital care per elderly American (8% per year) grew twice as fast as spending on patients under age 65 (3.8% per year). However, that pattern reversed itself between 1987 and 2000, when hospital spending among the population under age 65 outgrew such spending on elderly Americans by a three-to-one margin (3% versus 1% per year). The authors concluded that it was difficult to predict the future need for hospital beds with the current trend of physician investment in outpatient facilities and specialty hospitals. All of this bodes well for the outpatient imaging center—and the office-based physician practice.

Transluminal angioplasty was invented by the legendary Charles Dotter, MD, who is memorialized each year in the Dotter Lecture at the annual meeting of the Society for Interventional Radiology (SIR). This year in Toronto, the lecture was delivered by the insightful Andreas Adam, MB, BS, FRCR, whose work in Britain helped establish the value of metallic stents in biliary and gastrointestinal intervention. He noted that IRs are being overtaken in the placement of non-coronary stents, but challenged all present to go out and claim some unclaimed turf: esophageal dilation and stenting; duodenal and colonic stents; and tracheal and bronchial stents.
 

It is the nature of the subspecialty to evolve (and molt), so it is important for clinical IR services to always be on the lookout for new procedures to offer their patients. Many physician practices and outpatient imaging centers have recognized the demand for minimally invasive treatment of varicose veins. A presentation at the recent SIR meeting in Toronto by Robert White, MD, Yale School of Medicine, New Haven, Conn, underscored the need as well for the minimally treatment of varicose veins in the reproductive regions of both men and women, a procedure performed on an outpatient basis. Varicocele is a varicose vein of the left testicle that may cause pain, testicular atrophy, and infertility. It occurs in 10% of males as a result of a congenital absence of valves and is responsible for 40% of male infertility. Pelvic congestion syndrome (PCS) is a common but frequently misunderstood source of pain in women that is relieved by lying down, and is due to an acquired absence of valves in one or both of the ovarian veins. It is more common in women with multiple pregnancies and often associated with varicose veins of the legs.

Pediatricians who treat boys 11 to 13 should be educated to look for varicocele. And gynecologists should be educated on the source of PCS in women, which is difficult to discern during a pelvic examination because the pressure is relieved in the prone position, though easily visualized on MRI. It is not uncommon for women suffering PCS to be referred to as many as seven or eight specialists before they are finally referred to a psychiatrist. Performing this service is a natural complement to both vein ablation and UFE, and a marketing campaign for this outpatient procedure could mean relief for many desperate women.
 

Although the value of establishing a clinical office practice for interventional radiology has been recognized by many practices, there are still quite a few radiology practices that are sitting on the fence. Bob Smouse, MD, an interventional radiologist at Central Illinois Radiological Associates, Columbus, conducted an in-depth study of the direct and indirect costs associated with setting up a clinical office for interventional radiology, and found that it was a break-even proposition, with technical fees covering all costs. Considerable ancillary imaging is generated for the practice.

Read more: http://www.imagingeconomics.com/library/200603-01.asp

Once a decision is made to establish a clinical practice, a choice must be made between an IDTF or an office-based practice. To qualify for Medicare reimbursement, IDTFs must comply with a specific set of rules that often are more restrictive than those required for radiology physician group practices. And while there is no difference in the Medicare payment mechanism between an IDTF and a physician practice, the restrictions can have an impact on the overall operating costs of the entity.

An office-based practice is an option only if the following criteria are met