Expanding opportunities for interventional radiology practice

Most radiology groups practice within a hospital facility setting, but many also work in non-hospital offices. Outside the hospital, interventional radiologists might provide services in an Ambulatory Surgery Center (ASC) or Office-Based Lab (OBL).  Participating in the ownership and operation of such facilities requires commitment of time and money, but there is an opportunity for financial rewards as well as more control over the practice environment.

Sandy Coffta

Hospital facilities can be less than optimal settings for interventional radiology (IR) practice. The interventional suite might be at capacity, out of date, or shared with other specialists competing for use of the space. Scheduled procedures are often cancelled or delayed when emergency procedures take priority. The hospital schedule and equipment upgrades are mostly out of the control of the IR group. 

An outpatient facility can ease the overload at the hospital while providing patients with a more pleasant environment for lower-acuity procedures, leaving the hospital department more available for inpatients and emergent cases. While interventional radiologists will continue to practice in both sites, participating in an outpatient center expands the opportunity for diversification of their practice, thereby reducing the risk of being tied to a single facility. The availability of a new source of cash flow can help to stabilize a practice and attract well-qualified candidates.

Practicing in an office-based setting offers many advantages, such as:

•  The physicians have a much greater voice in the selection of the office’s imaging equipment, and more flexibility in decisions to upgrade it -- a process that is often drawn out and cumbersome in a hospital environment.
• Ownership of the scheduling process affords several advantages -- the schedule can be set based on the doctor’s preferences and it can help assure maximum patient throughput. An office typically is better at the collection of patient demographic and billing information that will maximize revenue.
• The electronic medical records (EMR) system needs to be one more suited to a general medical office than a traditional radiology-focused system. Its selection should involve both the physician and administrative staff, as each party will have their own view of important features. The physicians will benefit from having a system they have chosen rather than one imposed by hospital mandates.
• The office setting and correct EMR system will enhance the IR’s ability to capture evaluation and management (E/M) visits and bill them when appropriate for additional revenue.
• With management control, the physicians can hire more non-physician providers (NPP) to make the operation more efficient without the budgetary limitations present in many hospital environments. While NPP services must be billed in the name of the NPP and reimbursement from Medicare is at 85% of the physician reimbursement, the cost of those services is lower than it would be for a physician. The services available to be provided by NPPs is guided by state law. 

 A freestanding outpatient facility can be set up as an ASC, an OBL, or a hybrid. An ASC is more highly regulated by state laws, which can be restrictive and costly.  Facility licensure, accreditation, and added safety requirements vary from state to state and add to the cost and complexity of ASC operation.  They are usually more suited to surgical procedures than interventional radiology procedures, although in an ASC where both are available there can be a synergistic benefit among the physician specialists. While not beyond the capabilities of physician practice management, operating an ASC is typically more suited to be an adjunct to a hospital’s operations. 

A promising future

Payers have long been rewarding non-facility settings. At the federal level, Medicare rules determine which procedures are allowable to be performed in an ASC or an OBL. A recent article from ReedSmith covers the history and current state of the Medicare Covered Procedures Lists. The authors conclude that Medicare regulatory changes for 2026 “create a promising future for growth in the OBL sector, particularly as to those procedures that relate to interventional radiology services.” 

This opportunity is being driven by an expansion of the list of permitted OBL services combined with the  Medicare Physician Fee Schedule (MPFS) Site of Service adjustment that shifts reimbursement in favor of global billing in office settings.  Commercial payers can be approached by OBL management to negotiate favorable fee schedules for procedures that can be moved outside the costlier hospital or ASC setting. It is important to have payer contracts in place before beginning operation of the office so that reimbursement rates are known in advance and collections are not delayed. 

Additional risk

As you would expect, the greater financial and operational rewards of an OBL are coupled with additional risk. Building a stand-alone facility, whether it is an ASC or OBL, is a big undertaking involving skills that the average physician may not possess. A practice with strong in-house management, perhaps one that already has an established imaging center, is in a good position.

However, there are professional consultants available who can help put the project together as well as to provide operational management. Joint ownership with a hospital or complementary physician practice can spread the cost, workload, and also help to assure the office’s success through patient volume.