IRs must “demonstrate the positive impact they have on generating revenue”, SIR discussants urge

Matthew Hawkins (L) and Raymond Liu

During the annual scientific meeting of the Society of Interventional Radiology (SIR; 20–26 March, online), Matthew Hawkins and Raymond Liu jointly hosted a session conveying the value of interventional radiology (IR) services. During the session, the touched on how interventional radiologists can communicate the value their field brings to hospitals and health systems and what other interventionalists can be doing to help move the field forward. Interventional News caught up with Hawkins and Liu for a discussion on the topic.

How can interventional radiologists communicate the value their field brings to hospitals and health systems?

MH: IR has become a specialty that treats a multitude of conditions in nearly every area of the body. Our specialty is an essential component to many revenue-generating service-lines offered by hospitals, such as organ transplant, oncology, stroke care, and trauma. In addition to some of the more complex interventions performed by interventional radiologists, our specialty has become healthcare system experts of central venous access, minimally-invasive biopsies, enteric access management, and percutaneous drainage procedures. But while interventional radiologists are valued for their universal skillsets, it has been difficult for the specialty to communicate how these skillsets translate to the bottom line for hospitals and health systems.

The most important thing interventional radiologists can do is to demonstrate the positive impact they have on generating revenue, containing costs, optimising resource utilisation, and providing high-quality patient care. As it pertains to quality, hospitals/healthcare systems value improved outcomes for patients, shorter lengths of stay (LOS), avoidance of unnecessary admissions, and post-discharge outpatient management to avoid re-admissions and financial penalties. They want to invest in specialties that can deliver on these targets. We know that IR does this, but having robust data and research to support it will be crucial in the future. We hope that interventional radiologists will conduct more research into these areas to further support IR as a value-driven, patient-centered specialty.

How have you personally worked with colleagues across disciplines to provide best patient care? How do you initiate forming an interdisciplinary team—what are the opportunities here?

RL: Interventional radiologists are always open to working in partnership across specialties, and there are more opportunities for partnership with other physicians than many realise. In developing an interdisciplinary team, it starts with identifying the holes within your health system that need filling. Where could your services be most useful in a team environment? Where do you think a team could provide the most value? The next step is to simply reach out to the other physicians within that service-line and have a conversation. Find out if they are interested in forming an interdisciplinary team. Most likely they will be enthusiastic about working together because we all have the same goal—getting patients the best care they deserve. The final step is to get support from hospital leadership. Their backing will help to nurture your team model and even scale it up for the future so it can continue to grow. A great example beyond the well-known oncology model are Hereditary Haemorrhagic Telangiectasia (HHT) teams that draw in specialists such as ENT, haematologists, geneticists, and pulmonologists.  And, of course, multidisciplinary teams should not just be considered for clinical issues—at Massachusetts General Hospital, we have created interdisciplinary teams for operational redesign, such as on-time efforts for first case in the operating room, or best practice workflows for anaesthesia support for IR.

A strong team that works across specialties is better for both physicians and patients, so I encourage other interventional radiologists to reach out to their colleagues if they are interested in working in this capacity.

What are the biggest challenges to the spread of IR generally, and how can interventional radiologists work on combating these?

RL: Some of the biggest challenges facing the profession include misperceptions among referring physicians and hospital administrators about what interventional radiologists can do. For a long time, interventional radiologists have been viewed as technicians, but as the field has exploded into other realms of treatment across all areas of the body, other physicians continued to hold the same notions about interventional radiologists’ capabilities. Yes, we can help treat a patient’s complex condition, but we can also provide patients the full clinical spectrum that allow discussions around all treatment options. We need to ensure that other physicians understand that we can be a partner in their patients’ care. Interventional radiologists can change this by strengthening relationships with other physicians in other specialties; by demonstrating to hospital administrators the ways interventional radiologists can help generate revenue, contain costs, and provide patients high-quality care.

I would also say access to IR services is a hurdle our specialty needs to overcome. In some metropolitan areas, there is an abundance of IR specialists that allow many choices for patients. But in many areas, even just a few miles outside major cities, there is a dearth of IR physicians that can address complex conditions and provide best practice treatments. Our specialty needs to identify those geographical areas, as well as improve communication of our services in those locations where there are interventional radiologists, and ensure that every patient has access to an interventional radiologist anytime.

What are biggest misconceptions pertaining to pediatric IR, and how can these be addressed?

MH: As endovascular equipment has continued to get smaller and smaller, it has made many minimally-invasive IR procedures safe for children. Now, rather than open surgical procedures, many paediatric diseases can be treated with minimally invasive, image-guided treatments. Pediatric IR is evolving rapidly and has become an essential specialty in the management of vascular malformations, paediatric organ transplant, and many paediatric benign bone tumors. Paediatric interventional radiologists have also become institutional experts in less-complex, but critical procedures, such as biopsies, enteric access, and central venous access, which are necessary for the care of a wide-array of paediatric diseases. In general, parents are grateful to have minimally-invasive, image-guided alternatives to open surgery.

Thriving paediatric IR practices are generally based out of tertiary referral paediatric hospitals, with an increasing percentage of pediatric interventional radiologists obtaining subspecialised paediatric IR training to supplement their foundational adult IR residency curriculum.

Matthew Hawkins is a paediatric vascular interventional radiologist and associate professor at Emory University and the Children’s Pediatric Institute, Atlanta, USA.

Raymond Liu is an interventional radiologist at Massachusetts General Hospital, Boston, USA. He is a Society of Interventional Radiology (SIR) board member and executive director of Partners HealthCare International (PHI).


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