UNIVERSITY OF WISC ONSIN–MADISONUNIVERSITY OF WISC ONSIN–MADISON

Can An Interventional Radiologist

Survive In Today’s Turf War?

John Swietlik, MD, Paul H Yi, MD, Nathan Kim,

MD & Jie Nguyen, MD, MS

Department of Diagnostic Radiology

University of Wisconsin-Madison

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Disclosures

The authors have no financial disclosures

relevant to this electronic exhibit.

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Introduction• Increasing numbers of imaging-assisted endovascular and cardiac

procedures are being performed by non-Interventional Radiologists.

• This trend has raised concerns amongst Interventional Radiology (IR)

physicians regarding the financial viability of the field.

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“Between 1997 and 2002, procedure volume in percutaneous

peripheral arterial interventions grew at faster rates among

cardiologists, vascular surgeons, and other physicians than it did

among radiologists.”

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Let the Turf Wars Begin• As a result, there has been concern about turf wars between IR

and other endovascular and cardiac procedure-oriented fields

for decades.

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Goals & Objectives

• The purpose of this study was to assess the

differences in maximum Medicare reimbursements

to IR, VS, and Cardiology physicians.

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In other words…

Can the field of IR remain financially

viable in today's healthcare market?

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Methods

• The Medicare Provider Utilization and Payment Database

is a publicly available database provided by the Centers for

Medicare & Medicaid services (US Government

organization) that discloses all Medicare payments by

dollar amount to physicians from 2012 to the present.

• This database was queried for all IR, VS, and Cardiology

physicians who received Medicare reimbursements in

2014.

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Methods

• The top 50 physicians in each specialty queried who received

the most Medicare reimbursements in 2014 were searched for.

• Of these, the total Medicare reimbursements made to each

physician was tabulated.

• Average total Medicare reimbursements were compared

between the three specialties using T-tests and ANOVA

(significance set at p<0.05).

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Results

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No significant difference between the three specialties'

average total payments, although there were trends

toward significance (p=0.008).

Specialty Mean (USD) Min Max

Vascular Surgery $2,405,198 $1,453,301 $10,978,358

Cardiology $3,027,008 $1,911,600 $14,801,647

Interventional

Radiology$1,311,979 $965,738 $6,437,855

Average Total Medicare Reimbursements By Specialty

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Results

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• In further sub analysis, there was…

• No significant difference when comparing IR to Vascular Surgery

(p=0.20).

• However, there was a significant difference for IR compared to

Cardiology (p=0.003)!

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IR makes less… but there is hope!

• 50 highest-reimbursed IR physicians are paid less than their counterparts

• However, they are still able to maintain a high level of reimbursement relative to average salaries of US physicians.• Maximum Medicare reimbursement for IR was $6,437,855 and the

average of the top 50 was $1,311,979

• The average salary of an IR is $518,1641 compared to the average US physician salary of $294,0004.

• Our results suggest that it is possible for an IR physician to remain financially viable and successful even in the midst of turf wars.

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How can IR keep it’s turf?

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Interventions grew at faster rates among other subspecialists than it did among

radiologists, resulting in radiologists’ market share decline. However, total

procedure volume among radiologists continued to grow. Thus, despite the erosion,

interventional radiologists can still maintain a strong position in this rapidly growing

field.

“There are valid reasons why radiologists should be the ones doing these

procedures: first, because in any given hospital, radiologists are generally

the physicians with the best training and most experience”

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Limitations

• We did not assess the specific procedures that comprised

these reimbursements.

• This is an area for future study, both for specific procedures, # of

procedures, and reimbursements per procedure as a guide for how

to build a profitable practice or explain differences.

• This is a select group of physicians:

• May not be applicable to all in the specialties.

• However, does demonstrate the ‘upper limit’ or ‘ceiling’ for

reimbursements.

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Take-Home Points• Top Medicare earners in IR make less than Cardiology and

Vascular Surgery.

• However, IR can be reimbursed very highly compared to other

subspecialties.

• How these differences breakdown based on procedure #, type

and reimbursement/procedure are unclear and should be

studied in the future.

• Additionally, determining the practice patterns of these high

earners can serve as a model for future generations of IR to

remain financially viable in the current healthcare system.

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Thank You!