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LOS ANGELES -- It's up to interventional radiologists themselves to demonstrate their value to the healthcare system, as suggested by practicing clinicians here who shared ways to maximize one's appreciation from various stakeholders.

With RVUs down, "we're not viewed as profit centers as much as we used to be," said Michael Brunner, MD, of the William S. Middleton Memorial Veterans Hospital in Madison, Wis., speaking at the . But there's still "intangible value" that interventional radiologists bring in.

"It's just not as well recognized," he said. "We do so many things that we would be impossible to replace." He listed diagnostic radiology, vascular surgery, interventional cardiology, general surgery, and surgical oncology as just a few examples of fields where he and his colleagues end up sharing turf from time to time.

The problem is that their delivery of high-value healthcare -- say, percutaneous abscess drainage, image-guided biopsy, transjugular intrahepatic portosystemic shunts, central venous access, and liver-directed therapy -- is rarely matched in recognition or reward, Brunner said.

Recognition for Service

To see the indirect value that services provide, take the master carpenter, Brunner said: "They're the ones that build cabinetry and do the real finish work. What they do is give the ability for less-skilled practitioners to do work quickly while the master fixes it at the end. It's one problem-solver who fixes things, absorbs the inefficiencies."

In this sense, interventional radiologists are the master carpenters, "enabling success where many fail," even when much of their work is "unseen."

Quaternary-care hospitals with these clinicians do a service for other institutions by letting them cherry-pick cases as they themselves take on more complex ones, Brunner continued. "They let primary, secondary, tertiary centers get away with doing their thing ... to survive and get things done at a cheaper level.

"What I'm suggesting here is that basically if other services do simpler cases due to cherry-picking -- or less-skilled or more risk-adverse providers can produce the same procedures that we do and IR [interventional radiology] is consulted to ensure success -- we would get credit for either the revenue or productivity that we enable.

"This is not to suggest that IR be compensated from revenue accrued by other services, but rather that numbers be used to show IR's invisible but quantifiable contribution."

Brunner's take-away was that the total value of interventional radiology goes beyond its own visible productivity numbers.

Correct E&M Billing

Compensation also follows billing and if not done carefully, leaves a gap between the interventional radiologist's care provided and the pay actually received, according to another presentation at the meeting.

Sarah White, MD, MS, of Medical College of Wisconsin in Milwaukee, reviewed her efforts there to have billing templates made, such that in 2012, clinicians were finally documenting in a billable way to reflect the services and time actually taken to treat a patient. Work RVUs jumped immediately from below 100 to around 200 within the year, she said.

Yet case volumes haven't increased, she noted. "It's the way we bill."

White's colleagues weren't immediately on board with the evaluation and management (E&M) billing templates at first, she said -- until she shared with her co-workers that she had made her salary back through these payments.

"Give me the templates. We're doing this today. I'm starting this today," her department chief finally said.

On top of these templates, another factor in improving E&M payments, according to White, is that physicians understand the billing process and the importance of appropriate attestations.

IR Registry Participation

Centers that have joined the Merit-based Incentive Payment System (MIPS) may have reporting requirements fulfilled when they participate in the from the American College of Radiology (ACR) and SIR.

For interventional radiologists, it's also an opportunity to get data demonstrating their value to the healthcare system, Jeremy Collins, MD, of Northwestern Medicine in Chicago, told the SIR 2018 audience. Like White, Collins suggested a system of standardized templates, only this time for structured reporting.

This facilitates a more streamlined data-extraction process for not just MIPS, but for any quality-improvement program, he said, noting that SIR offers free standardized report templates online.

There are just initial costs to set up the the TRIAD site server (ACR's image and information exchange) and then a low annual fee to ACR, Collins said. "The barriers to entry are fairly low."

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