SIR 2024
General IR
Tamer Elashyi, MS, CPPS
Medical Student
TCOM
Financial relationships: Full list of relationships is listed on the CME information page.
Akhilesh Pillai (he/him/his)
Medical Student
McGovern Medical School UTHealth Houston
Financial relationships: Full list of relationships is listed on the CME information page.
Jacob Underwood, DO
Resident
UT Southwestern Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Anil K. Pillai, MD
Section Chief
University of Texas Southwestern
Disclosure information not submitted.
Provide a background on the payment models for interventional radiology.
Describe capitated payment models, with examples from other procedural specialties.
Examine the impact of adapting capitated payment model in interventional radiology.
Discuss potential future capitated payment models with examples
Background:
Healthcare costs in the US have soared to an unsustainable 18.3% of the GDP, totaling $4.3 trillion annually, with one of the highest per capita expenses globally. Paradoxically, the quality of healthcare in the US lags many developed nations. To address this issue, the Institute of Health Improvement (IHI) proposes a radical shift from fee-for-service (FFS) to value-based care (VBC) to provide high-quality care at a more reasonable cost. FFS relies on transactional payments for individual services, while VBC is transformative, linking payment to care outcomes and costs. Currently, interventional radiology (IR) practices are predominantly FFS-based. The transition to value-based care is a critical concept that will shape the future payment model for IR and the broader healthcare system.
Clinical Findings/Procedure Details:
Fee-for-service (FFS) systems drive excess medical service utilization, prioritizing quantity over quality and favoring complex treatments over preventive care. Shifting from FFS, where physicians face no financial accountability for quality or cost, to population-based capitated (PBC) models represents the extremes. In between, pay-for-performance (P4P) rewards providers for meeting specific targets (e.g., regular diabetic check-ups), while episode-based payment (EBP) bundles payments for treatments like knee replacements. Financial risk escalates from FFS to P4P to EBP, peaking in PBC, where physicians assume substantial financial responsibility for both quality and cost of care. This transition acknowledges the need for value-based healthcare.
Conclusion and/or Teaching Points:
The shift to value-based care prioritizes quality outcomes and cost-effectiveness over mere volume. Transitioning to this model in interventional radiology necessitates defining key performance indicators and regular measurement. The ACR has suggested a P4P approach for radiation monitoring. EBP in IR might apply to specific cases like locoregional therapies for pre-transplant patients or as part of diagnosis-related group (DRG) payments. This exhibit provides an overview of the need for value-based care and outlines potential payment models in interventional radiology during the transition.