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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 WISCONSIN–MADISON Disclosures

The authors have no financial disclosures relevant to this electronic exhibit.

University of Wisconsin–Madison 2 UNIVERSITY OF WISCONSIN–MADISON Introduction • Increasing numbers of imaging-assisted endovascular and cardiac procedures are being performed by non-Interventional Radiologists.

“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.”

• This trend has raised concerns amongst Interventional Radiology (IR) physicians regarding the financial viability of the field.

University of Wisconsin–Madison 3 UNIVERSITY OF WISCONSIN–MADISON 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.

University of Wisconsin–Madison 4 UNIVERSITY OF WISCONSIN–MADISON Goals & Objectives

• The purpose of this study was to assess the differences in maximum Medicare reimbursements to IR, VS, and Cardiology physicians.

In other words… Can the field of IR remain financially viable in today's healthcare market?

University of Wisconsin–Madison 5 UNIVERSITY OF WISCONSIN–MADISON 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.

University of Wisconsin–Madison 6 UNIVERSITY OF WISCONSIN–MADISON 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).

University of Wisconsin–Madison 7 UNIVERSITY OF WISCONSIN–MADISON Results

Average Total Medicare Reimbursements By Specialty

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 $1,311,979 $965,738 $6,437,855 Radiology

No significant difference between the three specialties' average total payments, although there were trends toward significance (p=0.008).

University of Wisconsin–Madison 8 UNIVERSITY OF WISCONSIN–MADISON Results

• 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)!

University of Wisconsin–Madison 9 UNIVERSITY OF WISCONSIN–MADISON 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.

University of Wisconsin–Madison 10 UNIVERSITY OF WISCONSIN–MADISON How can IR keep it’s turf?

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”

University of Wisconsin–Madison 11 UNIVERSITY OF WISCONSIN–MADISON 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.

University of Wisconsin–Madison 12 UNIVERSITY OF WISCONSIN–MADISON 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.

University of Wisconsin–Madison 13 UNIVERSITY OF WISCONSIN–MADISON References

1. Bassett, M. (2014, December 01). Radiologists' Compensation-and Workload-Increasing. Retrieved May 01, 2017, from http://www.rsna.org/NewsDetail.aspx?id=14256 2. Drucker, E. A., & Brennan, T. A. (1994). The Turf War over Peripheral Vascular Intervention. Radiology, 193(2). doi:10.1148/radiology.193.2.81a 3. Eng, J., Mysko, W. K., Weller, G. E., Renard, R., Gitlin, J. N., Bluemke, D. A., . . . Scott, W. W. (2000). Interpretation of Emergency Department 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). doi:10.1016/j.jvir.2016.12.979 6. Levin, D. C., Parker, L., Eschelman, D. J., Sunshine, J., & Busheé, G. (1999). Do Interventional Radiologists Pose a Significant Threat to the Practice of Vascular Surgery? Journal of Vascular and Interventional Radiology, 10(8), 1007-1011. doi:10.1016/s1051-0443(99)70184-3 6. Levin, D. C., Rao, V. M., & Orrison, W. W. (2004). Turf wars in radiology: The quality of imaging facilities operated by nonradiologist physicians and of the images they produce. Journal of the American College of Radiology, 1(9), 649-651. doi:10.1016/j.jacr.2004.02.025 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!

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