Maximizing Profit with Hybrid ASC / OBL Development for Interventional Radiologists

Keywords: hybrid ASC/OBL, irASC, interventional radiology, outpatient procedures, CPT codes, reimbursement, insurance industry, healthcare compliance, financial return

The convergence of multiple trends has opened up a promising business opportunity for interventional radiologists – the ownership of interventional radiology ambulatory surgery centers (irASCs). In the past, ASC ownership and the associated revenue from Medicare and other payors were largely accessible to surgeons in various specialties, but interventional radiologists faced limitations due to the absence of appropriate CPT codes and an image perception challenge. However, recent developments have changed the landscape, presenting interventional radiologists with a new avenue for profit and growth.

Regulatory Change Creates New Possibilities

A regulatory change has paved the way for the emergence of irASCs. The addition of over 40 surgical CPT codes for interventional radiology procedures, including 10 added in 2016 to Medicare’s Ambulatory Surgery Center Fee Schedule, now enables the billing and collection of facility fees for outpatient interventional radiology procedures. These facility fees can be substantial, ranging well into four figures per procedure, depending on the CPT code. As a result, performing certain interventional radiology procedures in an irASC setting becomes financially advantageous, with all-inclusive fees often far more cost-effective than hospital charges.

Shifting Professional Image

Interventional radiologists are now undergoing a shift in their professional image. Traditionally viewed as radiologists with interventional skills, they are increasingly positioning themselves as interventionalist surgeons with radiology expertise. This new self-perception emphasizes patient care and places patients as the primary beneficiaries of their services. A similar transformation is taking place in other interventional specialties, such as interventional cardiology.

Payors Embrace Physician-Owned ASCs

The insurance industry’s stance on physician-owned facilities has also evolved. While resistance was evident in the past, payors now recognize the cost savings associated with moving procedures outside of traditional hospital settings. Physician-owned ASCs, including irASCs, offer significant financial advantages to both patients and payors, leading to greater acceptance and support from insurance carriers.

Structuring Successful irASCs

Creating a successful irASC requires a well-coordinated approach involving various stakeholders. Key considerations include determining the ownership structure of the facility – whether it will be solely owned by interventional radiologists, a traditional radiology group, or through a joint venture with a hospital. Compliance issues, especially concerning the federal Anti-Kickback Statute (AKS) and state law counterparts, must be addressed. Additionally, architectural, design, and construction considerations are crucial to ensure compliance with federal, state, and accreditation standards. A cohesive collaboration among clients, experienced developers, management firms, and healthcare legal counsel is essential to the success of irASCs.

Embracing the irASC Opportunity The birth of irASCs offers interventional radiologists and their groups a unique chance to capture both the professional and facility fees for numerous interventional procedures. By embracing the evolving landscape, conducting thorough analysis, and strategic planning, investing in a well-structured and designed irASC can yield substantial and sustained financial rewards. The integration of hybrid ASC/OBL development into interventional radiology practices marks a promising step forward, enhancing patient care while optimizing financial outcomes for interventional radiologists.