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Ghanem G, Tsai HHC, Durant C, Feigenbaum GS, Glaeser AM. Outpatient hospitalist-run procedure service bridges the gap in oncology care. Transfus Apher Sci 2024; 63:103936. [PMID: 38658295 DOI: 10.1016/j.transci.2024.103936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/03/2024] [Accepted: 04/20/2024] [Indexed: 04/26/2024]
Abstract
Hospitalist-run procedure teams enable expedited care in the inpatient setting. However, wait times for outpatient interventional radiology (IR) are long at our institution. Our study thus aims to compare the safety and wait times between procedural teams and IR placement of outpatient temporary hemodialysis catheters (THDC) for patients undergoing Chimeric antigen receptor T-cell (CAR-T) therapy apheresis. A retrospective chart review was conducted on all patients receiving outpatient THDC for CAR-T therapy from August 2019 until November 2022. During our study period, only 7 of the central lines were placed by IR, while 75 were placed by the procedure service. The average wait time from CAR-T consenting to procedure was 8.9 days for the procedure service and 14.7 days for IR. The 30 day minor complication rate was low - 2.7% in the procedure group, and 0% in the IR group. No major complications were noted in either group.
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Affiliation(s)
- Ghadi Ghanem
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Hsin Hsiang Clarence Tsai
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Catherine Durant
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Gary S Feigenbaum
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Alexandra Milin Glaeser
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Patel RA, Torabi SJ, Izreig S, Peter Manes R. Trends in Medicare Reimbursements for Commonly Performed Laryngeal Procedures from 2000 to 2021. Otolaryngol Head Neck Surg 2024; 170:1109-1116. [PMID: 38219740 DOI: 10.1002/ohn.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Numerous studies among different specialties have suggested that inflation-adjusted Medicare reimbursements have steadily declined in the last few decades. The objective of this study is to investigate whether this is true within the field of laryngology. STUDY DESIGN Retrospective Cross-Sectional Study. SETTING Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule. METHODS 2000-2021 fees for laryngeal surgeries (Current Procedural Terminology [CPT] codes 31530, 31531, 31535, 31536, 31540, 31541, 31545, 31546, 31551-31554, 31560, 31561, 31570), and laryngectomies (CPTs 31360, 31365, 31367, 31368, 31370, 31375, 31380, 31382, 31390, 31395) were gathered. United States consumer price index (CPI) was used to adjust all gathered data for inflation to 2021 US dollars. RESULTS During the study period, unadjusted reimbursement for non-facility and facility laryngeal surgeries decreased an average of 6.1% and 6.6%, respectively. When adjusting for inflation, non-facility and facility laryngeal surgeries saw an average decrease of 17.8% (p < 0.001) and 28.5% (p < 0.001), respectively. Unadjusted reimbursement for facility laryngectomies saw an average increase of 40.2%, correlating to an inflation-adjusted decline of 8.9% (p < 0.001). Among laryngeal procedures overall, there was an average nominal increase of 17.0%, correlating to a 20.3% inflation-adjusted decline. CONCLUSION In terms of inflation-adjusted dollars, reimbursements for laryngeal procedures have seen a large decrease in the last two decades. Understanding reimbursement trends is critical for sustainability of otolaryngology practices, and can be used by surgeons, hospital systems, and policymakers to guide future healthcare legislation.
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Affiliation(s)
- Rahul A Patel
- Frank H. Netter M.D. School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sina J Torabi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Said Izreig
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - R Peter Manes
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
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Lindquester WS, Chandra A, Dhangana R, Tublin ME. Percutaneous kidney biopsy trends in the Medicare population by specialty from 2011 to 2021: implications for nephrology training requirements and radiology referral patterns. Abdom Radiol (NY) 2023; 48:3506-3511. [PMID: 37668743 DOI: 10.1007/s00261-023-04030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To study trends in volume and reimbursement for percutaneous kidney biopsy (PKB) by physicians and advanced practice providers (APPs) for Medicare enrollees from 2011-2021. METHODS Claims from the Medicare Part B Physician/Supplier Procedure Master File (a national Medicare database) for 2011-2021 were extracted using Current Procedural Terminology codes for PKB. Total volumes were compared by provider specialty. Non-facility reimbursement, work Relative Value Unit (RVU) non-facility practice expense RVU, and malpractice RVU were compared. RESULTS Between 2011 and 2021, total volume of PKB by physicians and APPs increased from 30,753 to 34,090 (10.9%), with a peak of 37,882 in 2019 prior to the COVID 19 pandemic. Radiology performed the majority of procedures during the study period. Relative share for radiology increased from 67.6% to 81.1% while the relative share for internal medicine/nephrology decreased from 24.3% to 14.3%, accelerating between 2019 and 2020. Volume and relative share for APPs marginally increased (from 0.9% to 1.2%). Non-facility reimbursement decreased from $578.96 in 2010 to $568.76 in 2021 (1.7%), work RVU decreased from 2.63 to 2.38 (9.5%), non-facility practice expense RVU decreased from 14.10 to 13.71 (2.8%), and malpractice RVU decreased from 0.31 to 0.21 (32.3%). CONCLUSION Volume and total share of PKB performed by radiology increased over the study period. Conversely, internal medicine/nephrology performed fewer kidney biopsies. Despite the expanding role for APPs in other image-guided procedures, very few PKBs were performed by APPs throughout the study period. Reimbursement and RVU for PKB declined over the study period.
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Affiliation(s)
- Will S Lindquester
- Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, 100 Lothrop Street, Atlanta, GA, 30322, USA
| | - Ashay Chandra
- Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, 100 Lothrop Street, Atlanta, GA, 30322, USA
| | - Rajoo Dhangana
- Department of Radiology, University of Pittsburgh Medical Center, Presbyterian University Hospital Suite E204, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| | - Mitchell E Tublin
- University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213, USA
- Department of Radiology, University of Pittsburgh Medical Center, Presbyterian University Hospital Suite E204, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
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Lee P, Reeves RA, Lee P, Leung SS, Rao V, Ford RW. Updated trends in percutaneous renal arteriography among radiologists and other specialties. Clin Imaging 2023; 102:14-18. [PMID: 37453303 DOI: 10.1016/j.clinimag.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 06/10/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Prior studies have demonstrated an overall decline in percutaneous renal artery angioplasty with and without stenting from 1988 to 2009. We evaluated the recent utilization trends in percutaneous renal arteriography (PTRA) among radiologists and non-radiologist providers from 2010 to 2018. METHODS Data from the 2010-2018 nationwide Medicare Part B fee-for-service database were used to tabulate case volumes for PTRA. Annual utilization rates per 10,000 Medicare beneficiaries were calculated and aggregated based on physician specialty: radiologists, cardiologists, vascular surgeons, general surgeons, or others. RESULTS From 2010 to 2018, the overall utilization rate of PTRA markedly declined (-72% change; from 15.5 to 4.3 cases per 10,000 Medicare beneficiaries). Proportionally, the cardiologist share of PTRA saw the greatest decline, falling from 74% market share in 2010 (11.4/15.5 cases) to only 36% market share in 2018 (1.6/4.3 cases). The market share of PTRA performed by radiologists grew from 12% market share in 2010 (1.9/15.5 cases) to 28% in 2018 (1.2/4.3 cases); despite this, the absolute number of PTRA performed by radiologists saw a smaller decline over this period (-34%; 1.9 to 1.2 cases). CONCLUSION The total utilization rates of PTRA in the Medicare population has continued to decline from 2010 to 2018, likely due to clinical trials suggesting limited efficacy of angioplasty and stenting in the treatment of renovascular hypertension and other factors such as declining reimbursement. The overall and per-specialty rates continue to decline, reflecting an overarching trend away from procedural management of renovascular hypertension.
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Affiliation(s)
- Philip Lee
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Radiology, Division of Interventional Radiology, 111 S 11th St, Philadelphia, PA 19107, United States of America.
| | - Russell A Reeves
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Radiology, Division of Interventional Radiology, 111 S 11th St, Philadelphia, PA 19107, United States of America
| | - Patrick Lee
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Radiology, Division of Interventional Radiology, 111 S 11th St, Philadelphia, PA 19107, United States of America.
| | - Stephan S Leung
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Radiology, Division of Interventional Radiology, 111 S 11th St, Philadelphia, PA 19107, United States of America.
| | - Vijay Rao
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Radiology, Division of Interventional Radiology, 111 S 11th St, Philadelphia, PA 19107, United States of America.
| | - Robert W Ford
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Radiology, Division of Interventional Radiology, 111 S 11th St, Philadelphia, PA 19107, United States of America.
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Christensen EW, Nicola GN, Rula EY, Nicola LP, Hemingway J, Hirsch JA. Budget Neutrality and Medicare Physician Fee Schedule Reimbursement Trends for Radiologists, 2005 to 2021. J Am Coll Radiol 2023; 20:947-953. [PMID: 37656075 DOI: 10.1016/j.jacr.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/16/2023] [Accepted: 07/08/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE The Medicare program, by law, must remain budget neutral. Increases in volume or relative value units (RVUs) for individual services necessitate declines in either the conversion factor or assigned RVUs for other services for budget neutrality. This study aimed to assess the contribution of budget neutrality on reimbursement trends per Medicare fee-for-service beneficiary for services provided by radiologists. METHODS The study used aggregated 100% of Medicare Part B claims from 2005 to 2021. We computed the percentage change in reimbursement per beneficiary, actual and inflation adjusted, to radiologists. These trends were then adjusted by separately holding constant RVUs per beneficiary and the conversion factor to demonstrate the impact of budget neutrality. RESULTS Unadjusted reimbursement to radiologists per beneficiary increased 4.2% between 2005 and 2021, but when adjusted for inflation, it declined 24.9%. Over this period, the conversion factor declined 7.9%. Without this decline, the reimbursement per beneficiary would have been 9 percentage points higher in 2021 compared with actual. RVUs per beneficiary performed by radiologists increased 13.1%. Keeping RVUs per beneficiary at 2005 levels, reimbursement per beneficiary would have been 12.1 percentage points lower than observed in 2021. CONCLUSIONS Given budget neutrality, a substantial decline has occurred in inflation-adjusted reimbursement to radiologists per Medicare beneficiary. Decreases due to both inflation and the decline in conversion factor are only partially offset by increased RVUs per beneficiary, meaning more services per patient with less overall pay, an equation likely to heighten access challenges for Medicare beneficiaries and shortages of radiologists.
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Affiliation(s)
- Eric W Christensen
- Director, Economic and Health Services Research, Harvey L. Neiman Health Policy Institute, Reston, Virginia; Adjunct Professor, Health Services Management, University of Minnesota, St Paul, Minnesota.
| | - Gregory N Nicola
- Partner, Hackensack Radiology Group, PA, River Edge, New Jersey; ACR Board of Chancellors; Chair, ACR Commission on Economics
| | - Elizabeth Y Rula
- Executive Director, Harvey L. Neiman Health Policy Institute, Reston, Virginia
| | - Lauren P Nicola
- Chief Executive Officer, Triad Radiology Associates, Winston Salem, North Carolina; ACR Board of Chancellors; Chair, ACR Commission on Ultrasound
| | - Jennifer Hemingway
- Senior Research Associate, Harvey L. Neiman Health Policy Institute, Reston, Virginia
| | - Joshua A Hirsch
- Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts; ACR, Commission on Economics; Chair, ACR Future Trends Committee-Economics
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Spies JB. Communicating with Your Department Chair: A Primer on How to Advocate for Your IR Section. Semin Intervent Radiol 2023; 40:399-402. [PMID: 37927514 PMCID: PMC10622231 DOI: 10.1055/s-0043-1775719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Many interventional radiologists express concern about communicating their practice needs to their radiology department chairs. As a result, they may have difficulty getting support for hiring of additional physicians and staff, capital investments in equipment, and marketing of IR services. Some perceive that chairs have a preference for diagnostic radiology initiatives over interventional and want to know why. More importantly, they want to know how to approach their chair and succeed in their advocacy for IR. The key to success is understanding the perspective of the chair and the pressures and demands they face. That understanding allows the IR to propose their initiatives in a form that helps address some of the chair's needs and thus eases their path to success.
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Affiliation(s)
- James B. Spies
- Department of Radiology, MedStar Georgetown University Hospital, Washington, District of Columbia
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