Interventional Radiology Procedural Complexity: Evaluation and Management Services and Other Factors Associated With Higher Complexity Procedural Work.

Abstract

The provision of evaluation and management (E&M) services is crucial to the value of interventional radiology (IR) as a clinically integrated specialty. We aimed to assess E&M's association, as well as extent to which the radiologist and practice are focused on IR versus diagnostic radiology (IR share), with procedural complexity. Radiologists providing care to Medicare fee-for-service beneficiaries (2008-2023) were mapped to practices and the percentage of care they provided that was IR-related was computed using a 5% sample of these beneficiaries' claims. Practices with radiologists providing IR-related services were included, as were E&M services provided by nonphysician practitioners (NPPs) in radiology-only practices. Associations between procedural complexity (work relative value units [wRVUs]) and E&M services, practice IR share, and radiologist IR share were assessed using multivariable regression analyses. Overall, 29,844 practice-years met selection criteria. Higher practice IR share was associated with higher procedural complexity. The proportional odds that a procedure had ≥5 wRVUs was higher for practices billing >90% to 100% IR work compared with practices with >0% to 10% IR work (odds ratio, 1.62; 95% confidence interval, 1.34-1.96) as were the proportional odds for radiologists with a >90% to 100% IR share compared with a >0% to 10% IR share (odds ratio, 74.74; 95% confidence interval, 65.81-84.89). A 1-wRVU increase in either radiologist or NPP E&M wRVUs per procedure was associated with 0.14 (P = .045 or P = .038, respectively) more wRVUs per procedure. The degree of individual radiologist IR specialization, more than practice specialization, most strongly predicts the complexity of care delivered. NPP-provided E&M services were strongly associated with higher procedural complexity.