In other words, IRs get compensated without the sometimes messy patient prep and recovery. At times, this friction can stall referrals to IRs, with some physicians opting to recommend procedures they can perform themselves. Indeed, some physicians have gone as far as to learn the procedures that IRs typically perform in order to offer patients a fuller suite of procedure options. This turf war has left some IRs with fewer referrals, and as a result, the role of this specialty is changing. In the coming years, mending relationships with referring surgeons and expanding practices to include emerging interventional therapies will be essential for IRs to maintain procedure volumes.

 

With the rising patient preference for minimally invasive image-guided procedures over surgical alternatives, many nontraditional physicians are adopting these techniques. Because other physicians are learning these often highly-reimbursed procedures and eroding IR share of procedure volumes, IRs are finding patient referrals from other specialists increasingly hard to come by, particularly in the fields of peripheral vascular interventions and vascular access. Low pre- and post-procedure management in vascular access, for example, will put IR procedures at risk to interventional nephrologists, who actively provide full patient care. 

 

Even if the referring physician does not adopt an IR procedure, procedure compensation issues can leave many IRs with fewer procedures to perform. For example, treating uterine fibroids falls either under the purview of the IR or the Ob/Gyn; however, treatment volumes depend on Ob/Gyn referrals. Typically performed by an IR, uterine fibroid embolization (UFE) is a minimally invasive procedure in which IRs insert a catheter through the peripheral vasculature and block the uterine artery using tiny permanent embolization particles. UFE has a high success rate, few lasting side effects, and is much less invasive than the alternative surgeries, myomectomy or hysterectomy. Despite its potential, UFE procedure volumes are limited by reimbursement issues. Gynecologists are typically the first to detect uterine fibroids in a patient and recommend treatment type, UFE or the more established myomectomy or hysterectomy. If they refer for UFE, the gynecologist is still responsible for handling the patient’s post-procedure symptoms—which, although only present in about 40% of patients, can include severe acute pain, leukocytosis, nausea, cramping, and postembolization syndrome (PES)—while the IR receives payment for the procedure. As a result, the competing surgical therapies will limit growth in the volume of UFE procedures through 2014 because many physicians will continue to refer patients to these alternative forms of treatment. 

 

As a result of these poor referral patterns, IRs now are thus looking to mend their relationships with the primary and referring physicians with whom they are competing for a limited pool of patients. These include specialists from across the therapeutic spectrum, including Ob/Gyns, family practitioners, interventional cardiologists, vascular surgeons, orthopedic surgeons, pain management specialists, and more. To maintain procedure volumes and grow their businesses, IRs will need to engage in more aggressive practice marketing, targeting both referring physicians and patients themselves. IRs that focus their practice on one therapeutic area and heavily market the procedure they perform will build a reputation in that area for both referring physicians and patients. Developing relationships will be crucial to maintaining and expanding referral volumes.

 

To maintain and expand procedure volumes, IRs will also need to aggressively pursue growth opportunities. Supplementing their procedure offerings with techniques from emerging fields such as interventional oncology is one method of protecting procedure volumes. IRs already own a high share of interventional oncology procedures, and relatively few oncologists have expressed interest in adopting these procedures. For these reasons, The IR segment of the interventional oncology market will exhibit robust growth through 2011, particularly radiofrequency (RF) ablation cryoablation, chemoembolization, and radioembolization procedures. IRs will also find opportunity in other areas, such as pain management and vein treatment.

 

The efforts IRs put into improving referrals and expanding their procedure offerings will support this specialty in the coming years. The Society of Interventional Radiologists is working intensely to increase physician and internist education on patient care and technique expansion issues, including providing resources for IRs for developing and marketing their practices. To ensure the sustainability their practices, IRs will need to establish robust referrals streams that are not solely dependent on specialists that also perform the same types of image-guided interventions. IQ