Interventional radiology is “an operational and financial hedge” for hospitals during COVID-19, Mikin Patel (University of Arizona College of Medicine, Tucson, USA) and co-authors claim in Journal of Vascular and Interventional Radiology (JVIR).
“Under normal circumstances, interventional radiology (IR) efficiently cares for both inpatients and outpatients,” the authors note. “In response to the COVID-19 pandemic, IR has taken a more prominent role in the hospital, accounting for an increased share of both procedural volumes and gross charges at two academic medical centres [in the USA], the first with a total of 894 beds in Tucson, Arizona, and the second with 811 beds in Chicago, Illinois. This trend countered the observed, and notably opposite, trend towards a relative decrease in contribution from other prominent procedural services (surgery, cardiac catheterisation lab, and endoscopy).”
The JVIR report used aggregated departmental data from the two institutions studied to investigate procedural volume. At the start of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services gave the recommendation that all elective surgeries, as well as all non-essential medical, surgical, and dental procedures, should be cancelled or delayed during the pandemic. Therefore, at both medical centres evaluated in this study, procedural volumes across the hospital decreased year-over-year (35% and 69%, respectively) in April 2020.
However, IR procedural volumes decreased by a much smaller amount (22% and 35%, respectively). Over the same time-frame, procedural volumes in surgery, cardiac catheterisation lab, and endoscopy decreased by a much larger proportion: -45%, -30%, and -40%, respectively, in the Tucson centre, and -72%, -56%, and -81%, respectively, in the Chicago hospital.
At the medical centre in Tucson, total gross procedural charges for the hospital decreased 40% year-over-year in April 2020, but IR charges had only decreased 20%. For surgery, this decrease was more stark, at 44%. Gross procedural charges in the catheterisation lab declined by 35%, and endoscopy charges were reduced by 43% in the same month.
“The data above demonstrate that, while other procedural services such as surgery, cardiac catheterisation lab, and endoscopy have suffered decreased procedural volume and charges, IR has filled the void,” Patel and colleagues write in their brief research letter. “The resultant increased disparity in work performed and charges generated should be recognised by hospital administration as a source of procedural revenue that is relatively spared. Furthermore, the work performed by IR during the pandemic likely provides value by contributing to patient discharges and length of stay metrics, however the authors acknowledge this would be difficult to quantify.”
They note that the majority of IR procedures took place in the outpatient setting in 2019, while most surgery and catheterisation lab procedures were performed on inpatients (56% and 60%, respectively). As the COVID-19 pandemic led to suspension of non-essential procedures, Patel et al say that resources were diverted towards inpatient care. “Paradoxically, IR pivoted from a predominantly outpatient-based practice to a service focused on hospital in patients, while services that were predominantly treating inpatients in 2019 decreased their role,” they relate.
Speaking to Interventional News, Patel comments: “I do think that interventional radiology’s role in treating hospitalised patients will continue to grow whether or not we are under pandemic conditions. In the short term, the COVID-19 pandemic has exaggerated this trend. In the long term, I am optimistic the ‘new generation’ of interventional radiologists we have been training will push the advantages of IR therapies for patients.
“Ideally, hospitals will recognise the value IR brings in terms of efficacy, quality, and efficiency for patients. From the administrative perspective, it sometimes feels as if IR gets lumped in with the rest of radiology and is treated as a service to be ‘ordered’ by other physicians. It may be time for hospitals to start treating IR more like a surgical subspecialty, recognising the need for things like clinic space, scheduling support, and dedicated coders.”
“IR’s adaptation to the operational shocks of the COVID-19 pandemic was largely the result of two factors: efficiency in reconfiguring workflows and availability to treat patients,” the JVIR authors continue. “At both medical centres included in this report, IR departments promptly prepared for handling of COVID-19 patients by adding negative pressure air handling for IR suites, clearly assigning duties and personal protective equipment for staff, and establishing clear protocols on potentially aerosolising procedures requiring extra precautions. Notably, these changes took effect in IR before they were implemented in the operating rooms.”
In addition, interventional radiologists working at both institutions included in this study noted an increased number of consult requests for procedures which are traditionally areas of considerable overlap in scope of practice (central venous access, gastrostomy, nephrostomies, biopsies, and venous thromboembolism intervention). In many cases, other procedural services had rejected these consultations for lack of medical urgency, and IR was available and ready to treat these patients during the COVID-19 pandemic.
“The flexibility and motivation to accommodate the needs of the hospital are arguably core principles of IR which appear to be common across multiple institutions. During times of stress, these strengths allow IR to serve as an operational and financial hedge for ensuring the continued health of critically ill patients and burdened health systems,” they conclude.