“OBLs are generally easier to build and get going because they have less regulations than an ASC,” said Mark J. Garcia, MD, FSIR. Regulations and limitations usually focus on the level of anesthesia needed for a procedure, which is why interventions requiring more sedation are typically held in an ASC rather than an OBL.
Sometimes these two service sites can be run by the same IR, Dr. Garcia said. In this hybrid model, a facility can operate as an ASC on one day and as an OBL on others—though never at the same time. The hybrid model, Dr. Garcia says, increases volume while enhancing efficiency. However, ASCs are more expensive to build, and designation depends on state regulations.
Another way to categorize OBLs is based on their ownership, Dr. Garcia said. Solo individuals who own OBLs can benefit from all the revenue but do carry a higher risk and all of the financial burden. That’s why some physicians choose a partnership model, where the risk and burden is shared, as well as the benefits, workload and practice vision.
These partnerships can be single specialty (IR only), multispecialty or service-line oriented. “Service-line oriented OBLs that have a multispecialty team that only focuses on something like PAD or UFE work can be immensely successful and a huge service to the community,” Dr. Garcia said.
Some IRs pair with an equity partner to build their OBL, which comes with greater financial security, but sometimes at the potential loss of autonomy, quality and quantity, due to having non- providers involved in business decisions.
“There are so many types, and they all have benefits, but also the risks and challenges of private practice,” Dr. Garcia said. “The key is to do your diligence, evaluate your partners and think critically about the services you can provide to the community and whether you’re meeting their needs.”
Opening an OBL Aaron Kovaleski, MD, opened an OBL in 2020 with his partner.
“We have an equitable distribution of room time and overhead,” Dr. Kovaleski said, describing his practice as more like two practices within one office.
His practice is fully independent and has no hospital affiliation, though both he and his partner maintain privileges.
Dr. Kovaleski says he personally averages only five or so hospital procedures per year, usually because one of his patients are transferred in or— in the rare case—a patient needs general anesthesia. His partner, however, does more hospital work, as he takes on many oncology patients.
“Hospital privileges are always the hot topic,” Dr. Kovaleski said. “My suggestion is to get a lawyer and have them navigate the situation with you, so you can work with the hospital and see what workarounds are possible in case of exclusivity contracts.” However, if there’s no workaround possible, he says that while hospital privileges are nice they are not 100% necessary.
Financial benefits According to Blake P. Parsons, DO, the OBL space is a great financial option for physicians and patients alike.
“We save patients 35–40% on their bill compared to hospitals,” he said. “And I think the Centers for Medicare and Medicaid Services (CMS) is starting to come around to see that they can save money.”
Gerald A. Niedzwiecki, MD, FSIR, emphasized this by showing a friend’s recent hospital bill. His friend was in the hospital for one day for acute coronary syndrome. The hospital billed $30,000 for a heart catheterization with stent placement and another $20,000 for simultaneous left heart catheterization. The CT angiogram was $8,000, and a CT angiogram of the chest cost $5,000.
Dr. Niedzwiecki compared this to standard OBL rates, where a left heart catheterization pays $950, a CT angiogram of the abdomen and pelvis runs $400 and a CT angiogram of the chest is $260. In total, the patient was billed $92,000, and the hospital collected $76,000 of the bill.
irq.sirweb.org | 37 “We save patients
35–40% on their bill compared
to hospitals. And I think the Centers for Medicare and Medicaid Services
(CMS) is starting to come around to see that they can save money.”
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