come in and, on most visits, get things done in one visit.”
He also joked that patients like the free parking—but, in all seriousness, that’s part of the convenience and access. “You’re usually parking 50 feet from the front door,” he explained. “You know where you’re going—you’re not in a maze of a hospital.”
Overall, an OBL is a much more patient- centered approach than a hospital, he said. “We are usually a smaller group of people, so we all know the patients, and we are all invested in them doing well.”
Dr. Cumming and his staff can spend ample time with each patient, making sure they comprehend their diagnosis, procedure and options. “One of our goals in our clinic is to make sure we understand why the patient is coming and try and allocate the resources we need to take care of them so they can walk away from their visit understanding what the problem is and what we can do to help them,” he said.
Benefits and challenges The primary benefit of owning an OBL is also one of its biggest challenges: autonomy. IR owners are the final decision-makers, but that means they also must succeed at hiring and managing staff, buying and setting up equipment, marketing and building a referral base, and ensuring the lights stay on.
IR OBL owners must be strong, patient- focused clinicians and entrepreneurs, these owners said. It’s not for everyone.
“You’ve got to be willing to work through the obstacles that you’re inevitably going to run into,” Dr. Cumming said. “And there’s always another obstacle. I never
1987 FSIR designation FSIR
The society creates Fellowship status (FSIR) to recognize individual member contributions to advance IR as a specialty and their service to society. Since then, 785 members have achieved FSIR designation.
look down the road and see a straight line to where we’re going.” But that’s what being a business owner is all about, he said. “The people who are successful understand that the obstacle is the pathway forward.”
Two specific challenges are hospital privileges and financial investment. Some, but not all, states require hospital privileges or a transfer agreement for OBLs. Even without a requirement, privileges can be important to allow IRs to care for or follow up with their patients in the hospital when necessary. However, in some areas it can be difficult to obtain hospital privileges because of diagnostic radiology practices’ exclusive contracts with nearby hospitals.
“It’s regrettable that independent IRs are the only procedural specialty unable to easily obtain hospital privileges in the United States,” Dr. Julien said.
This is one of the reasons why it’s critical for an IR to evaluate the market in a specific area before opening an OBL. Is there a better area or state with more need and less competition where hospital privileges would be granted? Areas with limited healthcare access, like rural or frontier areas, may offer a better business opportunity, while also improving access in that community, Dr. Niedzwiecki said.
Independent IRs should use caution, as many procedures do not reimburse in the outpatient setting. Additionally, at first glance it may appear that Medicare and other payers reimburse OBLs at higher “nonfacility” or “global” rates compared to hospital-performed procedures, but Dr. Costantino said this is oversimplified.
The technical expense to the patient and insurance companies is much higher in the hospital setting. The hospital charges “piecemeal” for the technical and professional services, medical devices, sedation, etc., she explained. The fee that the OBL receives covers the technical and professional fees and all expenses related to the procedure. However, physician fees have faced several cuts in recent years, while costs for equipment and staff continue to rise. Patients and payers will hopefully start to recognize the enormous cost savings of OBL care, she said.
Opening an OBL is a hefty financial investment, much like launching a start-up company, Dr. Costantino continued. It can take a couple of years before the owner breaks even or begins to receive a salary. That makes it even more critical to have a solid business plan, select an ideal location and seek advice from other OBL owners. Interested IRs can find resources through SIR and the Outpatient Endovascular and Interventional Society. In addition, the SIR Business Institute is a 1-day entrepreneurial symposium offered each year that focuses on the business side of IR.
Despite the challenges, OBLs continue to hold appeal for many IRs and can offer a more efficient, less expensive healthcare model to patients. “This isn’t for everybody, and there’s no right or wrong way to practice interventional radiology,” Dr. Costantino said. “It’s about being happy in your job and practicing great medicine, because we’ve all earned that right.”
1988
SCVIR infrastructure grows, standards of practice committee develops
A year of many firsts for SCVIR! The office relocates from Pittsburgh to Reston, Va., the Standards of Practice Committee begins to create the society’s quality improvement guidelines for clinical practice, the corporate membership category is established and the society develops its first strategic plan.
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