- Email: [email protected]
Current clinical practice patterns of interventional radiologists in the United States
JVIR
’
Scientific Session
Wednesday
$517.58 (916.85), $804.46 (1285.94), and $884.04 (1260.49). A significantly higher proportion of MO providers accepted payments than both RO (98.6% vs 81.0%, po0.0001) and IR (98.6% vs. 89.9%, po0.0001). A significantly higher proportion of IR accepted payments compared to RO (89.9% vs. 81.0%, po0.0001). The mean total payment received per provider differed significantly across specialties (p ¼ 0.0001). MO providers, on average, received significantly more payment per provider during the study period (p o0.001) compared to all others and RO received significantly less (p o0.0001). Per provider payment were not significantly different between IR and SO (p ¼ 0.9) but were significantly less than MO. Conclusions: Among industry payments made to oncologic providers, MO received the highest median and corrected average amounts. MO was also the specialty with the highest proportion of providers receiving open payments.
3:54 PM
Abstract No. 358
Interventional radiology and the Sunshine Act: two-year analysis of the open payments database and comparison with related specialties A. Baadh1, D. Katz2, S. Islam2, P. Baadh2; 1Rush University Medical Center, Chicago, IL; 2WinthropUniversity Hospital, Mineola, NY
S155
Abstract No. 359
Why vascular surgeons and interventional radiologists collaborate or compete: a look at endovascular stent placements E. Keller1, M. Crowley-Matoka1, J. Collins1, H. Chrisman1, M. Milad1, R. Vogelzang1; 1Northwestern University, Feinberg School of Medicine, Chicago, IL Purpose: To understand how cultural differences between vascular surgeons (VSs) and interventional radiologists (IRs) affect their clinical decision-making and inter-specialty relationships. Materials: Endovascular stent procedure data was collected from 3658 procedures performed in a single hospital system between Jan. 2005 and Dec. 2015, using CPT codes. Aggregate counts were divided by provider specialty for each year and trends were assessed via correlation coefficients. This data was supplemented with a historical analysis of the two specialties and 26 conversational interviews with IRs and VSs about their approaches to patient care, views of their specialty and others’, and solutions to any expressed concerns. Interview transcripts were systematically coded according to constructivist grounded theory, a well-validated method for exploring social processes. Key themes were compared across specialties and practice environments in terms of frequency and emphasis. Results: During the 11-year period studied, endovascular stent placements were primarily performed by IR and VS with roughly equal division but some variability from placements by cardiology. However, IR’s share of these procedures slowly but significantly increased (r ¼ 0.7, p ¼ 0.02). Both historically and presently IR and VS have shared icons, training, and procedural territory. IRs tend to lay claim to treatments as masters of procedures whereas VSs base their claims on being masters of the treated diseases, leading to collaboration in some practices and bitter competition in others. The level of perceived inter-specialty tension was most associated with specialists’ awareness of and appreciation for specialty-specific values rather than differences in practice structure/reimbursement. In general, IRs and VSs viewed each other’s claims to shared territory more favorably than other specialties, e.g. cardiology. Conclusions: Understanding cultural differences between specialties is imperative for fostering better collaboration. As relatively small specialties with close histories, it is likely best for IRs and VSs to grow their shared territory together rather than competing for the same slice of the pie.
4:12 PM
Abstract No. 360
Current clinical practice patterns of interventional radiologists in the United States P. Balthazar1, C. Hawkins2, R. Duszak3; 1Emory University School of Medicine, Atlanta, GA; 2N/A, Decatur, GA; 3N/A, Atlanta, GA
WEDNESDAY: Scientific Sessions
Purpose: To characterize medical industry based payments made to U.S. based interventional radiologists (IR), identify trends in compensation, and compare their payment profile with those of other related specialties, including vascular surgeons (VS), interventional cardiologists (IC), and orthopedic surgeons (OS). Materials: For each group, the total payment number and amounts as well as mean and median numbers and amounts were calculated. The data was then re-analyzed after correcting for statistical outliers. For IR, VS, and IC, leading industry sponsors, payment amount, and any differences in payments from 2013 to 2014 were highlighted. Payments to IR were grouped by category and geographic location. The Kruskal-Wallis-Test was used for statisticalanalysis. Results: A total of $26,857,622 went to 1,831 IR physicians, representing 70.9% of active IR. Corrected mean payment was $597 and median $214. VS had a statistically significant higher corrected median payment amount compared to all other groups (po0.0001). Covidien-LP and Sirtex-Medical Inc. were the leading industry sponsors to IR. 64.6% of payments were for compensation for services other than consulting. There was no significant difference in payments received by geographic region. Conclusions: Over the two-year study period, interventional radiologists received a large number of payments from industry. Vascular surgery received a statistically significant higher median payment amount. Interventional radiologists appeared to have more limited financial ties with industry compared to other specialties, although variation exists. As the Open Payments Program continues to be implemented, it remains to be seen how this information will affect relationships among physicians, patients, and industry.
4:03 PM
’
S156
’
Wednesday
Scientific Session
WEDNESDAY: Scientific Sessions
Purpose: To identify patterns of procedural, non-invasive diagnostic imaging, and clinical evaluation and management (E&M) services provided by self-declared interventional radiologists (IRs) in the United States. Materials: Most recent 1) Medicare Physician and Other Supplier Public Use Files and 2) Medicare Physician Compare databases were obtained from the Centers for Medicare and Medicaid Services (CMS). We identified IRs as 1) physicians whose primary specialty was self-identifed as IR on Medicare claims or 2) physicians self-designating IR as a specialty during Medicare enrollment. Our primary outcome measure was the percentage of work relative value units (wRVUs) attributed to interventional services (both procedural and E&M) per IR. Our secondary outcome measures were sociodemographic factors (urban/rural, gender, years since graduation) per quartile of interventional wRVU percentage; and the percentage of units of service attributed to E&M services per IR. Statistical analysis included Chi-square, Student’s t-test, and logistic regression. Results: A total of 3,132 physicians self-designated to CMS as IRs. Nationally, fewer than 10% of self-declared IRs were female and only 0.3% practiced in rural areas. The distribution of interventional wRVUs was bimodal, with the most generalized quartile physicians focusing r5% of total work in interventional services, the most subspecialized quartile focusing Z91%, and the remaining half widely distributed in between. IRs with 430 years out of training were more likely to be in the most generalized quartile than in the most subspecialized compared with those r30 years (OR: 3.5; po0.0001). Females were more likely to be in the most generalized quartile than in the most subspecialized compared to males (OR: 2.0; po0.0001). E&M services accounted for only 1.4% of all services provided by IRs. Conclusions: Most self-declared IRs perform some combination of both interventional and non-invasive diagnostic imaging services. But, the distribution of IR subspecialization is strongly bimodal, with a quarter of IRs each focusing r5% and Z91% on interventional services. Despite recent emphasis on the clinical aspects of IR, E&M services remain infrequent for all.
4:21 PM
S. Hunt1, M. Silk2, J. Sprinkle3, G. Nadolski2, T. Gade4, A. Hillier2; 1Penn Image-Guided Interventions Lab, Philadelphia, PA; 2University of Pennsylvania, Philadelphia, PA; 3Penn Image-Guided Interventions Laboratory, Spokane, WA; 4Hospital of the University of Pennsylvania, Philadelphia, PA Purpose: To investigate variation in interventional radiology (IR) physician density across the United States in relation to overall physician workforce and disease density using geospatial mapping. Materials: A database of the number of registered active IR physicians by zip code was obtained from the Society of Interventional Radiology. These data were compiled
JVIR
and imported into ARC-GIS 10.0 (ESRI; Redlands, CA) and used to generate maps of IR physician number and normalized density relative to the census population across the United States. Overall physician density data were obtained from the Kaiser Family Foundation and AMA Physician Characteristics and Distribution datasets. Disease prevalence data were obtained from the CDC, NIH, and NCI portals, and used for co-registration with IR physician density maps. Visualization was performed with ArcView 10, and comparisons made using neighborhood density function. Results: here are an estimated 3,425 registered active IRs within the United States, representing approximately 1.1 IR per 100,000 US residents, or approximately 0.4% of the estimated active US physician workforce of 904,556. IR physician density by census population varies across states more than three-fold ranging from a high of 2.1 IRs/100,000 persons in North Dakota to a low of 0.6 IRs/100,000 persons in Mississippi. There is even more significant in-state variation in the density of IR physicians at the county level. When compared with maps of total physician density and disease density, significant outliers in IR physician density suggests areas of IR physician shortage. Conclusions: Interventional radiology physician number and density is heterogeneously distributed with significant regional variation at both the state and county level. Geospatial visualization and statistical techniques can provide insight into regional variation in physician access as related to burden of disease. SIR might consider enacting a Health Workforce Mapper as the AMA has done to pinpoint geographic areas of IR practice shortage.
Scientific Session 38 IO: TACE III Wednesday, March 8, 2017 3:00 PM – 4:30 PM Room 150B
Abstract No. 361
’ FEATURED ABSTRACT Geospatial mapping of interventional radiology physician density
’
3:00 PM
Abstract No. 362
Long-term outcomes of Surefire Infusion System for DEB-TACE for HCC M. Ertreo, T. Caridi, D. Buckley, G. Lynskey, A. Kim; Georgetown University Hospital, Washington, DC Purpose: To evaluate intermediate and long-term outcomes of the Surefire Infusion System (SIS) for delivery of DEBTACE in treatment of HCC. Materials: Single center retrospective chart review of all patients who underwent SIS DEB-TACE for the treatment of HCC and have been followed post TACE for at least 6 and up to 12 months. Disease response was assessed based on modified Response Evaluation Criteria in Solid Tumors (mRECIST) on follow up
’
Scientific Session
Wednesday
$517.58 (916.85), $804.46 (1285.94), and $884.04 (1260.49). A significantly higher proportion of MO providers accepted payments than both RO (98.6% vs 81.0%, po0.0001) and IR (98.6% vs. 89.9%, po0.0001). A significantly higher proportion of IR accepted payments compared to RO (89.9% vs. 81.0%, po0.0001). The mean total payment received per provider differed significantly across specialties (p ¼ 0.0001). MO providers, on average, received significantly more payment per provider during the study period (p o0.001) compared to all others and RO received significantly less (p o0.0001). Per provider payment were not significantly different between IR and SO (p ¼ 0.9) but were significantly less than MO. Conclusions: Among industry payments made to oncologic providers, MO received the highest median and corrected average amounts. MO was also the specialty with the highest proportion of providers receiving open payments.
3:54 PM
Abstract No. 358
Interventional radiology and the Sunshine Act: two-year analysis of the open payments database and comparison with related specialties A. Baadh1, D. Katz2, S. Islam2, P. Baadh2; 1Rush University Medical Center, Chicago, IL; 2WinthropUniversity Hospital, Mineola, NY
S155
Abstract No. 359
Why vascular surgeons and interventional radiologists collaborate or compete: a look at endovascular stent placements E. Keller1, M. Crowley-Matoka1, J. Collins1, H. Chrisman1, M. Milad1, R. Vogelzang1; 1Northwestern University, Feinberg School of Medicine, Chicago, IL Purpose: To understand how cultural differences between vascular surgeons (VSs) and interventional radiologists (IRs) affect their clinical decision-making and inter-specialty relationships. Materials: Endovascular stent procedure data was collected from 3658 procedures performed in a single hospital system between Jan. 2005 and Dec. 2015, using CPT codes. Aggregate counts were divided by provider specialty for each year and trends were assessed via correlation coefficients. This data was supplemented with a historical analysis of the two specialties and 26 conversational interviews with IRs and VSs about their approaches to patient care, views of their specialty and others’, and solutions to any expressed concerns. Interview transcripts were systematically coded according to constructivist grounded theory, a well-validated method for exploring social processes. Key themes were compared across specialties and practice environments in terms of frequency and emphasis. Results: During the 11-year period studied, endovascular stent placements were primarily performed by IR and VS with roughly equal division but some variability from placements by cardiology. However, IR’s share of these procedures slowly but significantly increased (r ¼ 0.7, p ¼ 0.02). Both historically and presently IR and VS have shared icons, training, and procedural territory. IRs tend to lay claim to treatments as masters of procedures whereas VSs base their claims on being masters of the treated diseases, leading to collaboration in some practices and bitter competition in others. The level of perceived inter-specialty tension was most associated with specialists’ awareness of and appreciation for specialty-specific values rather than differences in practice structure/reimbursement. In general, IRs and VSs viewed each other’s claims to shared territory more favorably than other specialties, e.g. cardiology. Conclusions: Understanding cultural differences between specialties is imperative for fostering better collaboration. As relatively small specialties with close histories, it is likely best for IRs and VSs to grow their shared territory together rather than competing for the same slice of the pie.
4:12 PM
Abstract No. 360
Current clinical practice patterns of interventional radiologists in the United States P. Balthazar1, C. Hawkins2, R. Duszak3; 1Emory University School of Medicine, Atlanta, GA; 2N/A, Decatur, GA; 3N/A, Atlanta, GA
WEDNESDAY: Scientific Sessions
Purpose: To characterize medical industry based payments made to U.S. based interventional radiologists (IR), identify trends in compensation, and compare their payment profile with those of other related specialties, including vascular surgeons (VS), interventional cardiologists (IC), and orthopedic surgeons (OS). Materials: For each group, the total payment number and amounts as well as mean and median numbers and amounts were calculated. The data was then re-analyzed after correcting for statistical outliers. For IR, VS, and IC, leading industry sponsors, payment amount, and any differences in payments from 2013 to 2014 were highlighted. Payments to IR were grouped by category and geographic location. The Kruskal-Wallis-Test was used for statisticalanalysis. Results: A total of $26,857,622 went to 1,831 IR physicians, representing 70.9% of active IR. Corrected mean payment was $597 and median $214. VS had a statistically significant higher corrected median payment amount compared to all other groups (po0.0001). Covidien-LP and Sirtex-Medical Inc. were the leading industry sponsors to IR. 64.6% of payments were for compensation for services other than consulting. There was no significant difference in payments received by geographic region. Conclusions: Over the two-year study period, interventional radiologists received a large number of payments from industry. Vascular surgery received a statistically significant higher median payment amount. Interventional radiologists appeared to have more limited financial ties with industry compared to other specialties, although variation exists. As the Open Payments Program continues to be implemented, it remains to be seen how this information will affect relationships among physicians, patients, and industry.
4:03 PM
’
S156
’
Wednesday
Scientific Session
WEDNESDAY: Scientific Sessions
Purpose: To identify patterns of procedural, non-invasive diagnostic imaging, and clinical evaluation and management (E&M) services provided by self-declared interventional radiologists (IRs) in the United States. Materials: Most recent 1) Medicare Physician and Other Supplier Public Use Files and 2) Medicare Physician Compare databases were obtained from the Centers for Medicare and Medicaid Services (CMS). We identified IRs as 1) physicians whose primary specialty was self-identifed as IR on Medicare claims or 2) physicians self-designating IR as a specialty during Medicare enrollment. Our primary outcome measure was the percentage of work relative value units (wRVUs) attributed to interventional services (both procedural and E&M) per IR. Our secondary outcome measures were sociodemographic factors (urban/rural, gender, years since graduation) per quartile of interventional wRVU percentage; and the percentage of units of service attributed to E&M services per IR. Statistical analysis included Chi-square, Student’s t-test, and logistic regression. Results: A total of 3,132 physicians self-designated to CMS as IRs. Nationally, fewer than 10% of self-declared IRs were female and only 0.3% practiced in rural areas. The distribution of interventional wRVUs was bimodal, with the most generalized quartile physicians focusing r5% of total work in interventional services, the most subspecialized quartile focusing Z91%, and the remaining half widely distributed in between. IRs with 430 years out of training were more likely to be in the most generalized quartile than in the most subspecialized compared with those r30 years (OR: 3.5; po0.0001). Females were more likely to be in the most generalized quartile than in the most subspecialized compared to males (OR: 2.0; po0.0001). E&M services accounted for only 1.4% of all services provided by IRs. Conclusions: Most self-declared IRs perform some combination of both interventional and non-invasive diagnostic imaging services. But, the distribution of IR subspecialization is strongly bimodal, with a quarter of IRs each focusing r5% and Z91% on interventional services. Despite recent emphasis on the clinical aspects of IR, E&M services remain infrequent for all.
4:21 PM
S. Hunt1, M. Silk2, J. Sprinkle3, G. Nadolski2, T. Gade4, A. Hillier2; 1Penn Image-Guided Interventions Lab, Philadelphia, PA; 2University of Pennsylvania, Philadelphia, PA; 3Penn Image-Guided Interventions Laboratory, Spokane, WA; 4Hospital of the University of Pennsylvania, Philadelphia, PA Purpose: To investigate variation in interventional radiology (IR) physician density across the United States in relation to overall physician workforce and disease density using geospatial mapping. Materials: A database of the number of registered active IR physicians by zip code was obtained from the Society of Interventional Radiology. These data were compiled
JVIR
and imported into ARC-GIS 10.0 (ESRI; Redlands, CA) and used to generate maps of IR physician number and normalized density relative to the census population across the United States. Overall physician density data were obtained from the Kaiser Family Foundation and AMA Physician Characteristics and Distribution datasets. Disease prevalence data were obtained from the CDC, NIH, and NCI portals, and used for co-registration with IR physician density maps. Visualization was performed with ArcView 10, and comparisons made using neighborhood density function. Results: here are an estimated 3,425 registered active IRs within the United States, representing approximately 1.1 IR per 100,000 US residents, or approximately 0.4% of the estimated active US physician workforce of 904,556. IR physician density by census population varies across states more than three-fold ranging from a high of 2.1 IRs/100,000 persons in North Dakota to a low of 0.6 IRs/100,000 persons in Mississippi. There is even more significant in-state variation in the density of IR physicians at the county level. When compared with maps of total physician density and disease density, significant outliers in IR physician density suggests areas of IR physician shortage. Conclusions: Interventional radiology physician number and density is heterogeneously distributed with significant regional variation at both the state and county level. Geospatial visualization and statistical techniques can provide insight into regional variation in physician access as related to burden of disease. SIR might consider enacting a Health Workforce Mapper as the AMA has done to pinpoint geographic areas of IR practice shortage.
Scientific Session 38 IO: TACE III Wednesday, March 8, 2017 3:00 PM – 4:30 PM Room 150B
Abstract No. 361
’ FEATURED ABSTRACT Geospatial mapping of interventional radiology physician density
’
3:00 PM
Abstract No. 362
Long-term outcomes of Surefire Infusion System for DEB-TACE for HCC M. Ertreo, T. Caridi, D. Buckley, G. Lynskey, A. Kim; Georgetown University Hospital, Washington, DC Purpose: To evaluate intermediate and long-term outcomes of the Surefire Infusion System (SIS) for delivery of DEBTACE in treatment of HCC. Materials: Single center retrospective chart review of all patients who underwent SIS DEB-TACE for the treatment of HCC and have been followed post TACE for at least 6 and up to 12 months. Disease response was assessed based on modified Response Evaluation Criteria in Solid Tumors (mRECIST) on follow up