AJR October 2016

Sharon W. Kwan, Corresponding Author                Department of Radiology, Interventional Radiology Section                University of Washington Medical Center                Seattle, WA

“The Top Three Health Care Developments Impacting the Practice of Interventional Radiology in the Next Decade”

Although interventional radiology (IR) has evolved as new technologies and procedures have changed the way medicine is practiced, anticipated shifts in the population in conjunction with precision medicine and updated payment models are poised to disrupt health care as we know it. Therefore, proactive efforts are underway to prepare IR for a new era of health care that promotes the value of minimally invasive, targeted medicine.

1. What are the top three health care developments that will impact IR in the next decade?

The coming of age of precision medicine, transformation of health care payment models, and changing demographics of our population will have significant impacts on the practice of IR in the next decade.

2. What opportunities will exist for interventional radiologists to contribute to the tailored care of individual patients?

Interventional radiologists invented image-guided, localized therapies. If you think about it, treatments such as chemoembolization for cancer or stenting for peripheral vascular disease are all tailored for individual patients, so we are innately familiar with the premise of precision medicine. Much of the recent excitement around precision medicine concerns developments in drug therapy targeted to the specific molecular profile of an individual or disease. On this front, there is great potential for interventional radiologists to contribute to the care of the patient. We expect growth in the number of biopsies required to characterize disease and track response to therapy. Furthermore, targeted drugs may be more effective and/or less toxic if delivered locally, while certain systemic immunotherapies may be more effective when combined with localized treatments such as image-guided tumor ablation. If interventional radiologists work creatively and collaboratively with other specialties, there will be many opportunities for the field to contribute in this new era of tailored care of individual patients.

3. Are quality measures relevant to IR reasonable and achievable?

Yes, absolutely. Five quality measures developed and stewarded by the Society of Interventional Radiology have already been approved for use in the 2016 Physician Quality Reporting System. Also new for 2016 are reporting requirements for “cross-cutting” measures. These measures are designed to be broadly applicable across multiple providers and “patient-facing” specialties, and IR is no exception. However, there is definitely a need for more quality measures relevant to all aspects of IR. This is especially important given the varied nature of IR practices nationally.

4. How will practices afford to manage their quality reporting standards?

There is no doubt that quality reporting requires significant investments of time and money. A recent Health Affairs (March 7, 2016) found that general internists, family physicians, cardiologists, and orthopedists spent an average of 785 staff hours per physician per year managing quality reporting requirements. This translates to a cost of more than $15 billion annually just for these four specialties! Obviously, this is a huge problem. On the other hand, with the new Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015, it is anticipated that payments for services will be increasingly tied to providing high-quality, efficient care. There will be escalating financial ramifications: physicians who fail to meet certain thresholds face up to 9% in payment reductions while those exceeding a performance threshold will see up to 27% in positive adjustment payments. In other words, while it will be costly to manage these reporting requirements, the laws are designed to encourage practices to participate. Practices that want to decrease the financial impact of these new regulatory requirements have to be proactive and leverage existing resources. Organizations such as the American College of Radiology and the Society of Interventional Radiology are investing tremendous time and effort to help their members meet reporting requirements. For example, the soon-to-be launched IR Registry is a Qualified Clinical Registry which captures quality measurements through structured radiology reports and automatically sends them to the Centers for Medicare & Medicaid Services. It is critical for practices to stay informed and support these national efforts.

5. Why does the expanding ethnic diversity of the aging population add urgency to the need for a diverse physician workforce?

The evidence is irrefutable that large ethnic and socioeconomic disparities persist in health care. These issues will intensify as the populations we serve become increasingly diverse. Reducing disparities is not a simple matter of matching providers with the ethnic origin of patients (interesting aside: provider-patient racial concordance has not been shown to improve patient outcomes). Rather, a diverse physician workforce will provide the breadth of leadership and experience required to prioritize, develop, and institute the difficult systemic changes that will improve health outcomes for patients from all backgrounds.