SIR 2024
Office-based Procedures
Alexis Medema, BA, MS
Medical Student
Duke University School of Medicine
Disclosure information not submitted.
Brian P. Triana, MD, MBA
Resident Physician
Duke University Medical Center
Disclosure information not submitted.
Charles Y. Kim, MD, FSIR
Professor and Chief of Interventional Radiology
Duke University
Financial relationships: Full list of relationships is listed on the CME information page.
Jon G. Martin, MD (he/him/his)
Assistant Professor of Radiology
Duke University Medical Center
Disclosure information not submitted.
IR services may be performed at either hospital facilities (“facility sites”) or office-based labs (“office sites”). Office sites are typically lower cost settings, yet lack the ability to escalate care to an emergency department or inpatient service if needed. This work aims to characterize the utilization of facility and office sites of service for interventional radiologists (IRs) and advanced practice providers (APPs) within private practices (PP) and academic medical center settings (AMC).
Materials and methods:
Using CMS National Doctors and Clinicians downloadable file linked with Medicare services and procedure volume by provider from 2021, CPT code services and sites of service were collected for IRs and APPs at private practices and academic medical centers. Services were designated into three categories: E&M billing, simple IR (procedures unlikely to require E&M visits), and complex IR (procedures likely to require E&M visits). Work RVUs for each physician and the associated services were calculated based on the 2021 Physician Fee Schedule.
Results:
PP IRs and PP APPs performed a higher percentage of work RVUs at office sites compared to AMC IRs and AMC APPs for E&M billing, simple IR, and complex IR work RVUs (see table for results). Compared to baseline volumes of procedure work at office sites, PP IRs performed a higher percentage of complex procedure work RVUs at office sites (15.6% vs 9.1% baseline), while AMC IRs shifted complex procedure work away from office sites (1.5% vs 4% baseline). APPs at private practices had higher E&M work RVUs than procedural RVUs (178 vs 125). In contrast, APPs at academic practices had lower E&M work RVUs than procedural RVUs (97 vs 218).
Conclusion: PPs utilize office sites at higher rates compared to AMCs, both for E&M and procedural billing. APPs were utilized primarily in clinical roles in PPs or procedural roles in AMCs. Further work is needed to understand the drivers of these variations in utilization, which may include differences in reimbursement between sites, organizational agility to invest in expansion sites, or patient/physician preferences.