Interventional radiology has always been a specialty where innovation moves quickly. But there’s a shift happening within the healthcare landscape—particularly on the public policy level—and IR may be perfectly situated to enter a whole new age of innovation, according to 2024 Dr. Charles T. Dotter lecturer Ezequiel "Zeke" Silva, III, MD, FSIR.
Dr. Silva’s lecture was informed by his extensive experience advocating on behalf of interventional radiologists via formulating, crafting and pushing forward policy that is favorable to IR as a specialty.
Since the first meeting of interventional radiologists in 1975, IR has made huge leaps in both clinical and policy achievements, Dr. Silva said. Between that first meeting and the 1987 meeting in San Diego, membership grew from 109 fellows to over 500 IRs.
“We saw a new wave of members who were hungry for advancement,” said Dr. Silva. “They wanted to move the specialty forward fast. They were politically savvy, understood public policy and knew what to do to bring the specialty to the forefront.”
This spurred an era of tremendous growth, Dr. Silva said. Between 1987 and 1992, IRs managed to gain accreditation for specialty programs, created SIRPAC, established the annual meeting as a scientific and educational conference, and launched both SIR Foundation and the Journal of Vascular and Interventional Radiology.
These advancements were crucial for IR’s future public policy wins, according to Dr. Silva, because they provided members and advocates with meaningful products and value to bring to lawmakers.
During this time, IR also had a tremendous win in terms of reimbursement.
“In 1990, William Hsiao was creating a new Medicare system that revamped how physicians were reimbursed,” Dr. Silva said. “IR made a play for the inclusion of component billing, rather than complete coding.” Essentially, this would allow for the creation of CPT codes that better reflected the reality of IR procedures and described them alongside other procedural specialties, thus enabling more reliable reimbursement and better data for health policy research.
“By the time 1992 rolled around, IR had achieved wins with component coding, surgical and radiology coding, meaningful valuation and recognition as a specialty,” Dr. Silva said. “It was nothing short of remarkable.”
IR advocates could have stopped then and felt good about their progress, Dr. Silva said. However, significant healthcare policy changes every 5 years or so have since continued to impact both practice and reimbursement, such the Deficit Reduction Act of 2005, the Affordable Care Act, the Medicare Access and Reauthorization Act, and recent COVID-19 public policy.
“It makes you wonder, as we approach 2030, where will we go next?” Dr Silva asked. In his opinion, the topics that will dominate the next 5 years will be consolidation, value-based care and digital health and artificial intelligence.
The potential role of AI in healthcare has been a key theme of this year’s Annual Scientific Meeting, because the technology is advancing so fast. “Large language models are the topic of the moment. We talk about the cowboy origins of IR, but this is the new Wild West,” Dr. Silva said. “Our perception of AI went from infer, detect and analyze to understand, generate and interact.”
The computer is no longer finding information, Dr. Silva said, but generating it. And the AI future is coming quickly.
He encouraged attendees to imagine walking into the IR suite in the future age of IR, where AI models can pull out clinically significant data, comb medical records and provide predictive values for success and complications.
Luckily, there is a roadmap to follow. Dr. Silva cited the example of how in 2018 the IDx-DR was released, a camera utilized by ophthalmologists that can take images of the retina and then determine whether there is pre-diabetic change. It functions entirely autonomously and received FDA approval.
“Essentially, the FDA has now said that software can function as a medical device, the same as any devices we would place in our practices,” Dr. Silva said.
Figuring out how to code a machine learning device was a challenge, Dr. Silva said. As a member of the group making the designation, the challenge was in determining how to classify work done by nonhuman entities.
“I am proud of the RUC committee, and the work we do to represent what physicians actually do,” Dr. Silva said. “But it does pose the question of how we can think more broadly about the value of AI.”
As IRs continue to face these challenges, Dr. Silva encouraged attendees to ask themselves if those founding principles of Dr. Dotter—independence, innovation and insatiability—can still apply.
“There needs to be a balance between public policy and advocating on behalf of patients, and right now I worry the balance is moving away from physicians and patients into a space that’s becoming burdensome,” he said. “It’s time for us to maintain our spirit and move forward in policy circles and say who we are and provide proof of our innovation. We have to be insatiable in our quest for knowledge, research, education and representation.”
Circling back to the three main skills of an IR, Dr. Silva suggested that there are actually four key areas: imaging, technical, clinical and digital skills.
“There’s a lot of specialties who can do two or three of those,” Dr. Silva said. “But how many can be experts in all four, other than IRs?”
