Walking the Talk

A Rhode Island interventional radiology group heeds the call to become a full-fleged clincial care practice.walking the talk

During an American College of Surgery meeting in 1968, the man known as the father of interventional radiology, Charles T. Dotter, MD, warned that if radiologists didn’t begin to provide clinical care, they would eventually become nothing more than “high-priced plumbers.”

Dotter suspected that if radiologists continued to simply read images and write reports rather than provide comprehensive clinical care, other physicians would eventually supplant them in the health care industry. Since that meeting 45 years ago, Dotter’s quote has circulated extensively as his prediction has materialized and many radiology disciplines have slid toward commoditization.

While radiology practices continue to grapple with Dotter’s prophetic statement, Rhode Island Vascular Institute (RIVI) in Providence has successfully transitioned from a traditional technical model in which radiologists rarely interact with patients into a mature clinical model — a cornerstone of ACR’s Imaging 3.0™ initiative — for the practice of interventional radiology. “Interventional radiologists got this clinical model gospel early on, so we realized that if there was to be a future for interventional radiology as an image-guided subspecialty, we were going to have to move further up the value chain,” says Gregory M. Soares, MD, director of RIVI, director of vascular and interventional radiology at Rhode Island Hospital, and associate professor in the department of diagnostic imaging at Brown University’s Alpert Medical School. “We committed to taking referrals from both subspecialists and primary care physicians, instituting a covenant of taking care of patients, and establishing a patient-physician relationship, just like any other subspecialist.”

But RIVI’s interventional radiology department didn’t become a full-fledged clinical care practice overnight. Multiple steps were required to flesh out what it would mean to provide clinical care, get stakeholders on board with the idea, and reconcile the costs of radiologists seeing patients rather than reading images. The costs were of particular concern because seeing patients is reimbursed at a much lower rate than reading images. “We were required to put together business plans for almost everything we wanted to do at the beginning,” says Timothy P. Murphy, MD, professor of diagnostic imaging at Brown University’s Alpert Medical School and director of the Vascular Research Center at Rhode Island Hospital. “It took many, many years of ongoing discussions, and probably for close to the first 10 years we received a lot of scrutiny from many stakeholders, including our parent board of directors, system administration, partners, and the referring community.”

Selling the Plan

One of the forerunners in clinical care, RIVI took initial steps toward implementing the model in the early 1990s. The transition began with a few RIVI interventional radiologists who believed that the future of interventional radiology, if not radiology as a whole, depended on not only performing procedures and reading images but also on following patients through episodes of care. “We understood that if we wanted to be the people who continued to do these image-guided techniques and not just the people who innovated and developed the procedures, we needed to be on the same playing field as our clinical colleagues,” Soares says. “And the only way to do that was to have a robust clinical practice.”

Soares, Murphy, and other supporters of the clinical model began this evolutionary process by developing a general business plan that outlined how the clinical model would work and the benefits it would bring, including improved patient care and increased business over the long term. They then had to convince all of the stakeholders that the practice should pursue the approach — beginning with their fellow interventional radiologists. Soares says some of his colleagues were averse to the clinical care model because it requires a great deal more work than sitting in a room and reading images. “Instead of getting a call about a patient who needs an angiogram, you’re getting a call about a patient who has pain in his legs, and you’re going to have to manage the disease and follow the patient through that episode of care,” he says. “It’s a different way of approaching your involvement with the patient.”

Once the interventional radiologists were agreeable, the team talked to referring physicians and found that most of the subspecialists embraced the more clinical approach, because they were not always comfortable assessing patients for unfamiliar complications following interventional radiology procedures, Murphy says. Vascular surgeons were the only subspecialists resistant to the transition, and that’s because they preferred being the intermediary in referrals from primary care physicians, Soares notes. “Once you make the shift and you start becoming a two-way hub for referrals instead of just the technical person, then all of a sudden you are in a place where you’re on a level playing field with the clinicians,” he says.

To finish reading this case study, visit http://bit.ly/Img3Study.


By Jenny Jones

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