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Newswise — Reston, VA and Fairfax, VA —Interventional radiologists (IRs) that almost exclusively practice in their specialty provide more clinical evaluation and management (E&M) visits for their patients and perform more complex procedures than those who do a higher share of diagnostic imaging. These findings come from a national Medicare analysis of 30,467 radiologists, published in the Journal of the American College of Radiology by the Harvey L. Neiman Health Policy Institute in collaboration with IR experts.

Interventional radiologists receive specialized training to provide imaging-guided interventions and direct clinical care before and after these procedures. The study shows that as IRs concentrate more heavily on interventional work, the number of office visits for their patients—both pre-procedure and follow-up—increases. This longitudinal patient care distinguishes IRs from diagnostic radiologists.

While most IRs also interpret diagnostic imaging, a subset performs IR work almost exclusively (>90% of their total work). The researchers grouped radiologists by their proportion of IR-related work and found that procedural complexity, measured by average work relative value units (wRVUs), doubled with greater IR focus. Radiologists with >0–10% IR-related work averaged 1.52 wRVUs per procedure, whereas those with >90–100% IR-related work averaged 3.08 wRVUs per procedure.

The researchers then evaluated average E&M visits per procedure by radiologist. “Compared to radiologists who spend in the range of 30-50% of their work providing IR services, those with 90% or more IR focus performed about 3 times as many E&M visits per procedure,” said Eric Christensen, PhD, research director at the Neiman Institute and lead author of the study. “Our results show that clinical visits and procedural practice are interdependent. Protecting IR office hours time in radiology practices is essential for delivering more complex, higher-value procedural care.”

“Although E&M visits are reimbursed at lower rates than most procedures, the observed link to higher procedural complexity underscores the importance of preserving physician office time is an investment in delivering higher-value IR care,” explained Luke Wilkins, MD, professor of vascular and interventional radiology at the University of Virginia. “Some practice models erode IR clinical time to meet high demand for diagnostic imaging studies or low complexity procedural work—a tradeoff that may limit opportunities for advanced IR care.”

The study revealed wide variance in IR work concentration, reflecting the competing demand of diagnostic imaging. Nationally in 2022, there were only 1,366 interventional radiologists who did over 90% IR work. That number doubled to 2,859 IRs when the threshold was lowered to >50%. “To put these numbers in perspective, fewer than one IR per U.S. county spends the majority of their workday focused on their subspecialty,” noted Wilkins.

The study was a collaboration between researchers from the Harvey L. Neiman health policy institute and interventional radiologists who are members of both the American College of Radiology (ACR) and Society of Interventional Radiology (SIR). “This study is part of a broader initiative by ACR and SIR to work in concert to demonstrate the unique value of interventional radiology, which only became a distinct medical specialty in 2012,” said Eve Lee, MBA, chief executive officer of the Society of Interventional Radiology. “As radiologists who treat disease, interventional radiologists are directly responsible for patient outcomes and time in office hours is vital to their role.”

“This study affirms that when interventional radiologists are afforded the time to evaluate and follow their patients, the complexity and value of the care they provide increases,” said Robert A. Lookstein, MD, SIR president and professor of radiology and surgery at the Icahn School of Medicine at Mount Sinai, New York. “Protecting dedicated IR time to see patients in office hours is not merely an operational concern—it is fundamental to preserving the physician–patient relationship that defines our specialty and enables IRs to deliver comprehensive, longitudinal care that measurably improves patient outcomes.”

The study also explored the role of advanced practice providers, also called non-physician practitioners (NPPs; e.g., nurse practitioners), in delivering IR services in radiology practices. “We found that NPPs in diagnostic-focused practices primarily perform IR procedures, whereas NPP workload flips to 86% E&M services in majority IR practices,” said Christensen.

“IRs play a critical role in managing patient care in preparation for and follow up after a procedure. Despite the growing demand for diagnostic imaging, access to complex IR procedures (with the necessary associated office hours visits) must remain a priority,” said Dana Smetherman, MD, CEO of ACR.

“This study provides valuable insights for practice leaders, who should consider protecting IR office hours time and deploying NPPs strategically to expand E&M capacity under physician supervision,” noted Alan Matsumoto, MD, professor of interventional radiology at the University of Virginia and chair of the ACR Board of Chancellors.

To arrange an interview with a spokesperson, contact Nichole Gonzalez at ngonzalez@neimanhpi.org.