SIR is reaffirming its commitment to independent IRs via an updated position statement on exclusive contracts and carveouts. The 2015 position statement, which expresses SIR’s support for the rights of independent IRs to gain admitting privileges at hospital systems that hold exclusive contracts with other radiology groups, was updated in May.
In the updated statement, SIR stands by the position that in cases where hospitals permit exceptions to exclusive contracts for non-IR physicians performing IR treatments, the same exemption should be provided to independent IRs, so that they may admit and treat patients at those hospitals. Granting independent IRs admitting privileges ensures they are able to practice and that patients have access to high-quality IR care.
“SIR's updated position statement on exclusive contracts is a huge step forward in the overall vision of why IR became its own specialty over a decade ago, and a good start in modernizing the system to ultimately allow free independent IR practice for those who choose to do so,” said Raj Pyne, MD, FSIR. In the modern IR job landscape, many IRs choose to not be part of a DR/IR group, and this position statement helps to open that door, he said.
“By leveling the playing field to provide equal footing similar to our surgical counterparts by allowing admitting privileges, it allows expansion of outpatient IR labs, increases competition and the overall level of endovascular care, encourages strong clinical patient-centered care, and gives patients more access to IR. It is a strong statement to support the future of our specialty.”
The challenges of exclusivity
Diagnostic radiology practices frequently enter exclusive professional services contracts with their hospitals, with interventional radiology, by default, included under this contractual umbrella. However, nonradiologists are granted exclusions or "carve-outs" to provide treatments covered under the contract. These carve-outs provide an unfair advantage for other specialties to perform IR services, by excluding IRs not associated with the diagnostic group from operating in the hospital, impeding board-certified IRs from working independently and reducing patient access to IR care.
“In order for IR to progress as a specialty and reach its full potential, it must evolve beyond the fiefdom model where medical centers are controlled by individual DR groups that offer varying amounts of IR services, which are often largely eclipsed by providers from other specialties,” said Derek Mittleider, MD, FSIR.
Any provider who completes vascular surgery or cardiology training can obtain hospital credentials—regardless of the DR group and its exclusive contract—and provide a varying percentage of inpatient and outpatient interventional care as they choose, said Dr. Mittleider. But on the whole, graduates of IR training programs do not have that luxury.
“IRs can join and be beholden to DR groups that likely will require some percentage of DR work to ‘remain whole’ or avoid being ‘loss leaders,’” Dr. Mittleider said. “They can venture into outpatient work with the threat that they may not be able to obtain the necessary hospital privileges to obtain insurance credentialing. They largely lack the option to mix inpatient and outpatient work (apart from a DR group) as is common for cardiologists and vascular surgeons.”
SIR believes that independent IRs have the right to operate and have admitting privileges at hospitals, like other primary specialties, regardless of contracts in place. The current interpretation of exclusive contracts provides an unfair advantage to other specialties that perform IR treatments by artificially limiting the operations of available IRs.
“The revised SIR position statement pushes the envelope toward models adopted by other specialties. It states that exclusive contracts should be avoided,” said Dr. Mittleider. “An IR who wants to practice independent of a DR group should be able to obtain hospital privileges regardless of the hospital contract with a DR group. The result will be more competition, a broader spectrum of interventional care available for patients and greater flexibility in career options for IR physicians.”
Opening doors to collaboration
The position statement was updated to reflect the needs of members, but leaders say a secondary intention is to continue to propagate the idea that exclusive contracts are outdated and restrictive. By doing so, they hope to bring more stakeholders into the conversation and create opportunities for collaboration.
"The business of radiology is in a state of tremendous flux now and it would be prudent for the two specialties of DR and IR to initiate conversations, some of which may be difficult, to explore how the practice of diagnostic and interventional radiology will evolve,” said Alda L. Tam, MD, MBA, FSIR.
The conversations are beginning to happen, however. Last year, the American College of Radiology passed a resolution that states, “groups holding exclusive contracts should be open to exploring relationships (e.g., subcontracts, affiliations, etc.) that may benefit patients in their community, and whenever appropriate, may allow independent IR physicians limited admitting and treating privileges so as to optimize continuity of patient care."
“That resolution is complementary to our updated position statement, and indicates, in my opinion, that our diagnostic radiology colleagues are recognizing that this is a topic that should be discussed more openly,” Dr. Tam said. “Our updated position statement is an excellent first step.”
To read the full updated position statement, visit sirweb.org.
