Clinical practice By Melanie Padgett Powers


Outpatient IR The rise of the office-based lab


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nterventional radiology became a primary medical specialty 13 years ago. More and more IRs are embracing clinical identities, increasing their focus on longitudinal patient management, building patient relationships and caring for patients over multiple years.


It’s only natural then that the next evolution in IR expansion is the office- based laboratory (OBL), also called the office interventional suite. While IR OBLs first came onto the scene 20 years ago, interest has expanded recently among IRs seeking more autonomy.


“There’s been a big explosion of OBLs, and I think that’s because doctors are burnt out and tired of being handcuffed by administration and corporate medicine,” said Mary Costantino, MD, FSIR, owner and medical director of Advanced Vascular Centers in Portland, Oregon. “To go out on your own takes a leap of faith and investment in yourself, but I think there’s enough of us that are willing to do that because we love what we do, and we want to deliver the best care to people.”


For William H. Julien, MD, president of South Florida Vascular Associates, the motivation to open an OBL two decades ago was simply to have an additional location to perform procedures, since


1984 Society creates Dotter Lecture


At the annual members' meeting in Napa, Calif., members vote unanimously to create a named lecture to honor Dr. Charles Dotter. The society reaches 87 active and 6 associate members and decides to hold future annual membership meetings at the Annual Scientific Meeting. The 1984 Annual Scientific Meeting has 750 attendees and 25 exhibitors.


there was limited IR suite availability at his small community hospital.


“All the radiology groups in the city were blocking my hospital privileges. So, in desperation, I opened an OBL to offload the easy procedures,” Dr. Julien said. “Little did I know what a great idea it was. Before long, I was performing 90% of my cases in the OBL, especially the complex ones.”


Michael J. Cumming, MD, MBA, founded an OBL, Vascular & Interventional Experts, in Minneapolis in 2020. He had already been working partly outside the hospital system, first opening a vein center through the group practice he worked for and later opening an outpatient vascular center with private equity support. But he yearned for more independence.


Dr. Cumming learned about the OBL model after meeting Dr. Julien at a vascular conference and learning what true independent IR practice could look like. Twenty years ago, unbeknownst to each other, Dr. Julien and Gerald A. Niedzwiecki, MD, FSIR, both launched the first comprehensive endovascular and IR-focused OBLs, both in Florida. As pioneers in the space, they became friends and founded the Outpatient Endovascular and Interventional


1985


Society, a multidisciplinary group of IRs, vascular surgeons and interventional cardiologists.


But Dr. Cumming wasn’t convinced he could replicate the Florida model in Minnesota where healthcare was more consolidated and the “turf had already been carved up.” He also wasn’t sure how he would generate referrals or fit into the marketplace. But then he observed that his competitors were large practices offering a lot of procedures but not necessarily serving patients well. He knew he could home in on patient care and procedural excellence, so he decided to start by building an OBL that specialized in critical limb ischemia care.


“There is room for an independent physician, even in a crowded marketplace, as long as you do really good work and you take good care of people and treat them well,” Dr. Cumming said.


Patients appreciate OBLs because of the smooth, streamlined care under one roof and the personalized, comprehensive support patients receive, Dr. Cumming said. “We have everything under one roof in our OBL; we have ultrasound, a CT scanner and a C-arm. Patients can


1986


10 IRQ | WINTER 2025


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