Seminars in Interventional Radiology最新文献

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.

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.

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. The key to success is understanding the perspective of the chair and the pressures and demands they face. That understanding allows the IR to propose their initiatives in a form that helps address some of the chair's needs and thus eases their path to success.

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.

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. Increased contributions to SIRPAC are essential to be sure that the voice of IR is heard.

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. This article will outline the key components of Medicare and how they apply to physicians, hospitals, and ambulatory surgical centers to provide a basic structure for thinking about payment for medical services. This review of the fundamentals of Medicare payment will provide a framework for physicians to understand the financial incentives that underlie clinical and operational decisions in the healthcare system.

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. interact to create inequities in the delivery of interventional radiology (IR) care. Understanding and addressing health disparities in IR is crucial for improving real-world patient outcomes and reducing the economic burden associated with ineffective and low-value care. Finally, the importance of intentional mentorship, outreach, education, and equitable distribution of high-quality healthcare to mitigate these disparities and promote health equity in interventional radiology is discussed.