SIR 2024
Practice Development
Michelle M. Shnayder-Adams, MD, M.P.H
Resident
University of Michigan
Financial relationships: Full list of relationships is listed on the CME information page.
C. Matthew Hawkins, MD
Associate Professor of Radiology
Emory University School of Medicine
Disclosure information not submitted.
Julie C. Bulman, MD
Interventional Radiologist
Beth Israel Deaconess Medical Center, Harvard Medical School
Financial relationships: Full list of relationships is listed on the CME information page.
Ammar Sarwar, MD, FSIR (he/him/his)
Associate Professor of Radiology
Harvard Medical School / Beth Israel Deaconess Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Minhaj S. Khaja, MD, MBA, FSIR (he/him/his)
Professor of Radiology & Cardiac Surgery
University of Michigan
Financial relationships: Full list of relationships is listed on the CME information page.
Despite the incorporation of a business curriculum into the Accreditation Council for Gradual Medical Education (ACGME) requirements, few residents report a strong grasp on the business of medicine or have knowledge about the reimbursement process. In 2009, a survey of diagnostic radiology residents at the University of Washington found that more than 80% of participants reported little to no understanding of the relative value unit (RVU) scale and how radiology studies are reimbursed. In this educational exhibit, we will address fundamental topics in interventional radiology (IR) economics, aiming to ensure that every interventional radiologist gains essential familiarity with these concepts.
Clinical Findings/Procedure Details:
We will describe various healthcare delivery models and review various examples of alternative care delivery and payment models, including accountable care organizations, patient-centered medical homes, and bundled payments. Additionally, we will outline the CPT and RUC process to understand the steps for making a new procedure reimbursable, as well as the calculation for determining total reimbursement for a procedure. We will also touch on the National Correct Coding Initiative (NCCI) developed by CMS and Medicare Administrative Contractors (MAC), along with guidance on finding SIR Economics Committee carrier/coverage letters to assist in insurance appeals for IR procedure reimbursement.
Conclusion and/or Teaching Points:
The idealistic vision of entering the medical profession with only the knowledge to treat patients is antiquated, and many physicians lack comprehension of the complexities of billing and coding. This can result in practices struggling to maintain the viability necessary for patient access to their services. It is in both the best interest of physicians and their patients to have a basic understanding of healthcare economics and to actively contribute their expertise on a policy level. This abstract provides a brief review of healthcare economics and its relevance in an IR-centric context.