<Interventional radiology market.
Data from 2000-2001 SIR Socioeconomic Survey show that 65% of members
surveyed are providing preprocedure visits, 92% are making rounds
after the procedure, and 52% are providing postprocedure office
visits. Most members have and use hospital admitting privileges, 85%
and 74%, respectively. Seventy percent of those surveyed are receiving
direct patient referrals, and 74% reported an increase from previous
years.
Less than half of radiology practices (42%) are supporting
interventional radiologists? efforts to establish a clinical practice.
In addition, less than half of practices (43%) are providing
interventional radiologists with office space to see their patients.
Those groups that do support clinical practice are providing
interventional radiologists with personnel (74%) and time to see
patients (65%).
Source: SIR Socioeconomic survey.
http://www.jvir.org/cgi/content/full/14/9/1099
The 2000-2001 Socioeconomic Survey Report costs $125.00
The survey report summarizes the findings with particular focus on:
Practice Information Trends in Services Offered, Trends in Referral
Patterns, Purchasing Information for Equipment, Devices, and
Phamaceuticals Employment Issues, Marketing Techniques Employed and
Interest in Research
http://directory.sirweb.org/store/detail.cfm?itemnum=500&
State of the industry
In 2003 radiologists performed 75,581 interventional procedures in an
office setting. Non-radiologists performed 248,188 interventional
procedures in an office setting.
Number of imaging centers.
According to verispan there were 5,769 diagnostic imaging centers in
December 2004. As shown above approximately 42% have interventional
practices. So there are approximately 2422 imaging centers with
interventional practices.
Image center ownership 2004.
Other 38%
Private ownership 37%
Radiology Group 12%
Partnership with hospital 9%
Physician partnership 4%
In 2003 interventional radiation (with 7,452,385 scans) grew 6.7%.
http://www.imagingeconomics.com/issues/articles/2005-06_03.asp
There are 811 Medicare practitioners in the interventional radiology
specialty in the US 2003 Source: (Medicare Physician and Other
Practitioner Registry by Specialty 2004, Centers for Medicare &
Medicaid Services)
http://www.wrongdiagnosis.com/doctors/medicare-doctors-and-physicians-by-specialty.htm
Utilization of Imaging.
All interventional
Part B non HMO ? 8 million
All populaiton - 30 million
All Medicare ? 10 million
Per 1000 persons ? 102
Source: American College of Radiology. ACR.
http://www.acr.org/s_acr//sec.asp?CID=649&DID=14313
--------------------------------------------
Procedures.
Number of procedures and where taking place in 2003.
Radiologist
Office 156,057
All 2,785,904
Non Radiologist
Office 816,722
All 4,666,481
Source: Medicare physician supplier procedure summary annual masterfiles.
Source: Medicare physician supplier procedure summary annual
masterfiles http://www.imagingeconomics.com/view_large_image.asp?frmImgSrc=library/200506-03/200506-03_2_large.gif
Percent of interventional procedures and where taking place in 2003
Radiologist
Office 2.1%
Inpatient hospital 17.2%
Outpatient hospital, ER and other 18.1%
Non Radiologist
Office 11%
Inpatient hospital 25.7%
Outpatient hospital, ER and other 26%
Source: Medicare physician supplier procedure summary annual masterfiles.
http://www.imagingeconomics.com/view_large_image.asp?frmImgSrc=library/200506-03/200506-03_1_large.gif
UFE - 13,000 to 14,000 procedures.
Source: Society of Interventional radiology.
http://66.249.93.104/search?q=cache:Z_-fsR2NpT8J:www.ask4ufe.com/publication_pdfs/UFE_5year_release.pdf+procedures+interventional+radiology+data+%22+the+us%22&hl=nl&ct=clnk&cd=4
Radiologists performed 135,103 (17.8%) noncardiac therapeutic vascular
procedures in 1996.
Source: Do interventional radiologists pose a significant threat to
the practice of vascular surgery? Levin et al.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10496700&dopt=Abstract
Placing tunneled catheters in 1999 ? 33,758
Source: JVIR
http://www.jvir.org/cgi/content/full/12/10/1211/TBL1
Placing nontunneled catheters in 1999 ? 101,820
Source: JVIR
http://www.jvir.org/cgi/content/full/12/10/1211/TBL2
In 2003 Breast biopsies performed by radiologists? 83,177 procedures.
Radiologists benefit from uptick in breast biopsies by Emily Hayes.
http://www.diagnosticimaging.com/webcast05/showArticle.jhtml?articleID=174403121
Radiologists perform 88% of interventinal neuroradiology procedures.
Source: Diagnostic Imaging Online.
http://www.diagnosticimaging.com/dinews/2003111201.shtml
Radiologists performed 56.5% of deep bone biopsies in 1993 and 73.6% in 1998.
They performed 10.4% of superficial bone biopsies in 1993, a figure
that grew to 26.3% in 1998.
Between 1993 and 1998, lumbar discographies performed by radiologists
declined from 44.8% to 37.9%.
Disk aspiration - 44.6% in 1998 vs. 14.8% in 1993.
Selective and non-selective (lumbar) epidural injection - 6.1% in
1998, up from just 2.9% in 1993.
In 1998 radiologists performed just 1% of anesthetic, lumbar or
caudial epidural injections
Radiology's share of paravertebral facet joint nerve injections
declined from 8.2% to 3.9% between 1993 and 1998.
Source: Medicare.
http://www.auntminnie.com/index.asp?sec=ser&sub=def&pag=dis&ItemID=50070
In 1996, radiologists performed 4,700 renal artery interventional
procedure. By 2000, radiologists did 7,660 of these procedures.
Source: Medicare.
http://www.heartinfo.org/ms/news/520971/main.html
Types of procedure
Case study of a dedicated radiology practice.
Over a six month period, there were 731 interventional procedures
performed during the study period, including 284 spinal interventions
(vertebroplasty, ESI, IDET), 150 embolizations (laser vein ablation,
UFE, chemoembolization, and neuro), 130 angiograms (neuro, pelvic, and
peripheral vascular), 65 venous sclerotherapies, 26 PTA/stent, and 11
other.
Source: Society of Interventional Radiology (SIR).
http://www.diagnosticimaging.com/dinews/2004032703.shtml
Utilization of radiology procedures per 1000 medicare enrollees in 2001.
National average
Interventional
Ambulatory settings.
Angiography 31
Other imaging 52
Repair 34
All service settings
Angiography 57
Other imaging 99
Repair 59
Source: Utilization of Radiology Services in the United States: Levels
and Trends in Modalities, Regions and Populations. Mythreyl Bhargavan,
PhD, Jonathan H. Sunshine PhD.
http://radiology.rsnajnls.org/cgi/reprint/234/3/824
Case study - Riverside Radiology Associates.
Over a 4 week period 138 patients were seen 81 of whom were new (the
remainder were follow-ups). The 138 encounters led to orders for 42
MRI studies, 11 CT scans, 7 bone scans, and 58 ultrasound examinations
(or a total of 118 ancillary imaging studies). In turn, these resulted
in 31 angiograms, 9 angioplasty/stent procedures, 25 venograms, 31
spine intervention procedures (which included vertebroplasty, epidural
steroid injections, and discography), 41 embolization procedures
(which included fibroid embolization and treatment of varicose veins),
3 transjugular intrahepatic portosystemic shunt (TIPS) procedures, and
8 venous sclerotherapies.
This practice is a hospital based clinic with admitting privileges.
Before having admitting privileges, the practice tending to lose track
of patients. The admitting privileges allow them to be involved in the
pre- and post-procedural management of the patients, particularly with
the follow-ups to make sure they were doing well.
Two outreach tracks were set up to promote the clinic," says Flaherty.
"One directed communications toward referring physicians. The other
toward consumers."
Physician offices and the emergency department were visited by the
interventionalists and key administrators of the clinic. They
explained the service, the clinic, and the options awaiting their
patients.
Educational seminars were also provided.
The public was reached by participation in health seminars for
community groups and women's organizations.
There also was a traditional marketing component that involved display
advertising and use of the Internet. A newsletter was published.
Articles about the clinic appeared in local newspapers.
About 90% of the patients seen in the clinic go on to have an
interventional procedure performed, says McGraw. Of those, as many as
20% are admitted to the hospital for a stay of at least 1 night. Most
likely to be admitted are patients slated for uterine fibroid
embolization, renal artery angioplasty, iliac angioplasty, and, on
occasion, vertebroplasty.
"It's rare that a patient comes into our clinic and is immediately
admitted to the hospital," McGraw explains. "Usually, most of the
procedures we schedule for patients seen in our clinic are elective.
In these instances, the patient comes in during the morning, we
perform a physical examination, write the admitting order, perform the
procedure, round on the patient after the procedure, round again the
next morning, and, if we determine the patient is stable enough to go
home, we write the discharge order and summary."
"Most of the legwork on admissions, rounding, and discharge is
performed by a single staffer, our nurse-practitioner," says Flaherty.
"We've taken on some responsibilities that in the past were the
hospital's. Some of that has to do with scheduling and pre-certifying
We took those on because our staff had a better knowledge of how to
handle them.
Source: Admitting Privileges by Rich Smith.
http://www.imagingeconomics.com/issues/articles/2003-04_01.asp
This survey gives details of procedures performed by interventional
radiologists and whether they perform the procedure with their own
radiologists, with the help of non-radiologists with or without their
assistance. Procedures include peripheral angiography, perpipheal
angioplasty, thrombolysis, inferior ven cava filter placement,
percuatneous nephhrostomy, biliary drainage and lung biopsy.
Source: Political Trends in Vascular and Interventional Radiology: A
Randomized Survey.
http://radiology.rsnajnls.org/cgi/reprint/170/3/941
--------------------------------------------
Referrals
Most vascular centers are built on existing relationships that
participating physicians have established in their community, giving
the centers enjoy a built-in referral base. However some are trying to
expand outside those parameters.
Rodney Raabe, MD, an interventional radiologist at Sacred Heart
Medical Center, Spokane, Wash, notes that the vascular center in
process at that location is specifically targeting primary care
physicians.
We are at the level of sending out information, identifying ourselves,
and letting primary care physicians know we are an integrated vascular
program," Raabe says. "We are very active in screening programs, and
really are trying to involve ourselves at the primary care level. So
far that seems to be working.
Kieren Murphy, MD, director of interventional neuroradiology at Johns
Hopkins Hospital, Baltimore, chose to do a mass marketing campaign to
8,000 physicians. The campaign focused on information about
interventional neuroradiology and vertebroplasty in the form of a
brochure that included a card to fit into a physician's Rolodex.
"The campaign also gave physicians the ability to ask for more
information, and so far I have had more than 109 contact me for that.
These are people who fall outside of our referral base," he says.
Source: Marketing Vascular Service: High Tech to High Touch by Liz Finch.
http://www.imagingeconomics.com/issues/articles/2001-01_10.asp
We perform only some of our venous disease procedures in this office,"
says Smouse, explaining that the big-ticket interventional work still
takes place in hospital settings. "Mainly, this clinic is where we
conduct screenings and follow-ups of patients for peripheral vascular
disease and abdominal aortic aneurysms."
The contribution of interventional radiology is particularly
impressive in that of the nearly 600,000 imaging studies CIRA performs
annually, only about 10,000 are interventional-related.
"We do an average of 25 cases a day at OSF-St. Francis Hospital, close
to half of which are vascular-arterial work," says Smouse. "Over at
Methodist Hospital, we do about 12 cases a day. And at Proctor
Hospital, an average day for us is five cases."
75% of referrals come from primary care physicians.
To spread the word about its own outpatient interventional clinic,
Central Illinois Radiological Associates ran newspaper advertisements,
set up electronic brochures on multiple Internet web sites,
participated in community forums, and passed around promotional
literature at mammography centers, family practice doctors' offices,
health spas, and pharmacies.
"We even worked with our hospital's public-relations department to
generate free media coverage so that our story could be more widely
told," says interventional radiologist H. Bob Smouse, MD.
Smouse says his team also prepared newsletters about the clinic and
sent them to primary care physicians. "Additionally, we hosted local
symposia for the doctors: in February, we did one for podiatrists on
wound healing and limb salvage, and found opportunities in the course
of that gathering to present information about our vascular services."
Other ways to communicate with referring physicians have included
direct mailing, phone calls, and lunchtime meetings. "We're soon going
to begin sending our senior nurse-practitioner out on a regular basis
to visit physicians' offices and provide CME courses and in-services,"
Smouse says.
A next step will be to expand the clinic marketing to Central Illinois
Radiological Associates as a whole. Says Smouse, "It would make sense
for us to promote, for example, CT angiography in the context of the
CT diagnostic services our noninterventional radiologists provide.
http://www.imagingeconomics.com/issues/articles/2006-03_01.asp
This article looks at some of the problems faced by interventional
radiology clinics.
The way IR operates within radiology is the need of IR to be hospital
oriented by virtue of its surgical nature. This does not mean that IR
outpatient clinics are not springing up. But these clinics tend to be
for imaging and examining purposes rather than places to conduct
treatments. "Some basic interventions like dialysis are quite
reasonably done in an outpatient setting," Pentecost says. "A lot of
the procedures can be done outpatient-but many of them can slip into
inpatient in a hurry. If you are not in a hospital setting and the ER
and OR are not a couple of floors away, it's just not as comfortable
practicing.
Source: A marriage of inconvenience by George Wiley
http://www.imagingeconomics.com/issues/articles/2002-06_01.asp
-----------------------------------------------
2001 Allowed Charges for Medicare Physician Payment Schedule services
by Speciality/Provider Group.
Interventional radiology - $144,539,548
Source: 2001 Medicare Physician/Supplier Procedure Summary Master File.
http://66.249.93.104/search?q=cache:nHtaUp5pZfsJ:www.ama-assn.org/ama1/pub/upload/mm/363/medphyspymtschedul01.pdf+Medicare+physician+supplier+procedure+interventional&hl=nl&ct=clnk&cd=29
-------------------------------------
Market
The market for products used in interventional radiology is a diverse
and growing segment of the medical device market, totaling
approximately $500 million in 2002 in the U.S. and projected to grow
to over $800 million by 2005.
http://www.ahcpub.com/hot_topics/?htid=1&httid=1557
The interventional radiology market is expected to grow to $5.5
billion by 2006. Interventional CT is predicted to see the most growth
accounting for more than $2.3 billion by 2006.
Source: Frost & Sullivan
http://www.medicalimagingmag.com/issues/articles/2000-09_08.asp
There are 5000 practitioners in the US.
Source: OR Manager
http://ordesignandconstruction.com/news_trends/pdf/ORMVol21No3LinesBlurring1.pdf
8.5?11.5% of radiologists are interventionalists. By most definitions,
only slightly under half of interventionalists spend 70% or more of
their clinical work time performing interventional procedures.
Interventionalists work, on average, 56?58 hr weekly, a few hours
longer than other radiologists. The average interventionalist performs
procedures in five of the seven categories of procedures into which we
divided interventional radiology, compared with one or two categories
for other radiologists. The average interventionalist performs
procedures in five of the seven broad categories (such as MRI, CT, and
nuclear medicine) into which we divided all of radiology, much the
same breadth of practice as other subspecialists and also as
nonsubspecialists.
Source: A Portrait of interventional radiologists in the United
States. Sunshine et al.
http://www.ajronline.org/cgi/content/abstract/185/5/1103
http://www.veins1.com/news/MainStory.cfm/79>
----------------------------
Basic characteristics of radiology practices.
Results from the American College of Radiology?s 1999 survey.
http://www.ajronline.org/cgi/reprint/181/2/341
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