Revolutionizing Interventional Radiology: The Ascension of Office-Based Labs and ASCs
The healthcare landscape is undergoing a significant transformation, and at the forefront of this revolution is interventional radiology—a field renowned for its precision and innovation. Recent shifts in market dynamics and regulatory policies are propelling medical procedures towards cost-effective settings, with office-based labs (OBLs) and ambulatory surgery centers (ASCs) emerging as the pioneers of this evolution.
This transformation gained substantial momentum when the Centers for Medicare and Medicaid Services (CMS) expanded the ASC-covered procedure list (CPL) to encompass a broader range of interventional radiology procedures in 2020. This groundbreaking decision has had a profound impact on the interventional radiology landscape, opening the door to a future where cutting-edge procedures are no longer limited to traditional hospital settings.
The journey toward OBLs and ASCs as preferred settings for interventional radiology began earlier. In 2009, procedures related to minimally invasive embolizations started migrating to OBLs, marking the initial phase of this transition. Subsequently, in 2016, cases related to image-guided biopsies and drainage procedures joined this migration. The momentum continued with diagnostic angiograms being performed in ASCs in 2019, and a transformative moment arrived in 2020 when Medicare approved complex interventional radiology procedures for ASCs. These milestones have reshaped the future of interventional radiology.
Industry experts anticipate that CMS will continue expanding the ASC-CPL to include additional interventional radiology procedures, such as complex liver biopsies, uterine fibroid embolization, and transarterial chemoembolization. Some ASCs are already performing these procedures on commercial patients, marking a promising trend towards the inclusion of more interventional radiology interventions in the ASC-CPL.
Commercial payers are closely following these changes and aligning their strategies accordingly. Similar to their approach with complex interventional radiology procedures before their inclusion in the ASC-CPL, commercial payers are already covering these procedures, even before they are included in the Medicare CPL for ASCs. This proactive stance underscores their commitment to cost-effective, high-quality interventional radiology care in OBLs and ASCs.
Medicare has further reinforced this transition by introducing an outpatient procedure price comparison tool. This tool highlights the substantial cost advantages of ASCs. For instance, it demonstrates that a complex liver biopsy procedure (CPT 47011) costs $4,500 in an ASC, with a patient responsibility of $900, compared to $7,800 in a hospital, with a patient responsibility of $1,560. These cost disparities are compelling payers to incentivize the migration of interventional radiology procedures.
Bundled payment arrangements through Medicare Advantage are evolving, allowing providers to share savings generated from cost differences across various surgical sites of care. This dynamic further accelerates the migration of interventional radiology procedures to lower-cost settings.
These changes, combined with the rise of physician-owned ASCs and direct contracting entities, are poised to reshape healthcare systems’ care delivery and financial performance. To bridge potential revenue gaps when interventional radiology ASCs become prominent in their region, healthcare leaders must proactively develop comprehensive physician alignment and backfill strategies.
Strategies for Excellence in Interventional Radiology:
To thrive amid the transition of interventional radiology procedures to OBLs and ASCs, consider implementing these strategies:
Physician Alignment: Foster collaborations with radiologists, oncologists, and other specialists. Explore joint ventures in ASCs with both employed and independent interventional radiologists.
Market Differentiation: Develop innovative strategies to distinguish your healthcare system in the market. Leverage your position as a leading interventional radiology program and an integrated health system in the region.
Integrated Approach: Seamlessly integrate your interventional radiology ASC strategy into your overall health system strategy. Align joint-venture interventional radiology ASCs with employed and independent physicians to deliver high-value care.
Effective Marketing: Promote the benefits of your program, including advanced technologies, superior outcomes, patient-centered care, accessibility, and convenience.
Value Pursuit: Actively pursue payer and consumer value across all service sites. Expand programs for complex cases, such as complex liver biopsies and transarterial chemoembolization, to harness the full potential of interventional radiology ASCs.
The transformation of interventional radiology procedures to cost-effective settings reflects a multifaceted shift driven by clinical excellence, financial considerations, and strategic alignment. With a well-conceived strategy, proactive risk management, astute business insight, and effective management, healthcare systems can adapt to these changes while ensuring the highest standards of interventional radiology care. The time to embark on this journey toward the future of interventional radiology is now.