Seminars in Interventional Radiology

The mechanisms of payment for medical services are complicated and create predictable incentives. Physicians can benefit from understanding how hospitals, practices, employers, and payers understand payment, since this has a role in determining how certain patient care services are valued and prioritized. Type of hospital, location of service delivery, and a physician's relationship with the payer or provider entity can greatly impact the value of a physician's work. The landscape of payers is large, but Medicare payment has come to drive the behavior of many private payers...

Private equity acquisition of medical groups and health care organizations is becoming increasingly important in medicine and is a trend that is likely to continue for the foreseeable future. Some question the ethical implications of private equity acquisitions, since the clear goal of such organizations is maximizing profitability, which may or may not be in the best interests of either the patient population or the provider group. This article will describe the role of private equity in the medical marketplace, with a focus on the role of private equity in radiology and interventional radiology specifically...

Health care policy in the United States is made by nonphysician lawmakers and government employees. Through advocacy and lobbying, physicians have an opportunity to be involved in the process. Interventional radiologists (IRs) are the experts on issues related to IR. Government relation offers IRs the opportunity to engage with members of Congress, officials in Federal and State agencies, and State legislators to inform and influence their decision making. The Society of Interventional Radiology PAC (SIRPAC) is the only PAC to represent the interests of interventional radiology...

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Organizational structure has evolved over the past several decades, with physicians assuming more or fewer leadership positions over time. Regardless of the role of physicians in health care organizational leadership, constant meaningful communication with the hospital, radiology group, or greater physician group administrative leadership is vital for any group of IR physicians to be successful. Understanding what is considered important to hospital administration and, in particular, being closely aligned with the C-suite leadership, is paramount to having successful communication with these stakeholders...

No abstract text is available yet for this article.

The mechanisms for Medicare payment to physicians are complicated and, in fee for service Medicare, the value of a procedure code explicitly determines the payment to the physician and the out-of-pocket cost to the beneficiary. These codes are created and then valued for payment through a complex but reproducible and transparent process that allows for physician and specialty society input. This article describes the process and its implications for interventional radiology.

Simulation facilitates learning by imitating real-world systems or processes utilizing educational tools and models. Various fields, including business, aviation, and education use simulation for training. In healthcare, simulation provides trainees opportunities to develop procedural skills in a safe environment, building their understanding through hands-on interactions and experiences rather than passive didactics. Simulation is classified into low, medium, and high fidelity, based on how closely it mimics real-life experience...

While national healthcare expenditures per capita in the United States exceed those in all other Organisation for Economic Co-operation and Development (OECD) countries, measures of health outcomes in the United States lag behind those in peer nations. This combination of high healthcare spending and relatively poor health has led to attempts to identify high- and low-value healthcare services and to develop mechanisms to reimburse health care providers based on the value of the care delivered. This article investigates the meaning of value in healthcare and identifies specific services delivered by interventional radiologists that have accrued evidence that they meet criteria for high-value services...

Health services research (HSR) is a multidisciplinary field which studies access to drivers of health care service utilization, the quality and cost of services, and their outcomes on groups of patients. Since its foundations in the 1960s, there has been a large focus on HSR and using large data sets to study real-world care. Because interventional radiology (IR) is a dynamic field with foundations in innovation, research often focuses on small-scale projects. This review will discuss HSR including data sources, focus areas, methodologies, limitations, and opportunities for future directions in IR...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

The authors report a case of endobronchial migration of a POD packing coil following embolization of a pulmonary artery pseudoaneurysm in a patient with cavitary tuberculosis and its successful management by bronchoscopy-assisted removal of the coil. Coil migration may be secondary to continued cough and persistence of a bronchial to pulmonary artery fistula from tuberculous infection and inflammation.

Many interventional radiologists express concern about communicating their practice needs to their radiology department chairs. As a result, they may have difficulty getting support for hiring of additional physicians and staff, capital investments in equipment, and marketing of IR services. Some perceive that chairs have a preference for diagnostic radiology initiatives over interventional and want to know why. More importantly, they want to know how to approach their chair and succeed in their advocacy for IR...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Racial, ethnic, and gender disparities have received focused attention recently, as they became more visible in the COVID era. We continue to learn more about how healthcare disparities manifest for our patients and, more broadly, the structural underpinnings that result in predictable outcomes gaps. This review summarizes what we know about disparities relevant to interventional radiologists. The prevalence and magnitude of disparities are quantified and discussed where relevant. Specific examples are provided to demonstrate how factors like gender, ethnicity, social status, geography, etc...

Infertility affects approximately 15% of patients worldwide, with up to 40% of cases attributed to tubal disease, and up to 25% of those being proximal fallopian tube obstruction (FTO). Evaluation of tubal patency can be performed via laparoscopic chromopertubation, hysterosalpingography, or hysterosalpingo-contrast-sonography (HyCoSy). In patients with proximal tubal obstruction, fallopian tube recanalization (FTR) can result in up to 100% technical success rate with pregnancy rates of 12.8 to 51%. More pregnancies occur when oil-soluble contrast media are used versus water-soluble contrast media...

Uterine vascular anomalies (UVAs), while rare, can result in severe, life-threatening hemorrhage. An understanding of the presentation and management options for UVAs is important for interventional radiologists to appropriately evaluate and care for these patients. The authors propose a standardized terminology for UVAs to avoid confusion and conflating congenital from acquired vascular lesions, which have a different pathophysiology. Limited high-level evidence and no definitive guidelines for UVA management exist, although endovascular treatment with uterine artery embolization has generally become the first-line approach for symptomatic or persistent UVAs with high technical and clinical success rates...

Placenta accreta spectrum is increasing in prevalence and poses significant risks to obstetric patients. This article defines characteristics, diagnosis, management, and outcomes of placenta accreta spectrum, highlighting interventional radiology's role in its management as part of a multidisciplinary approach.