Evolution of Interventional Radiology Practice Phenotypes: Sedation, Clinical Integration, and Procedural Complexity...

Area of Science:

• Interventional Radiology
• Health Workforce Analysis
• Medical Economics

Background:

• The interventional radiology (IR) workforce has seen significant growth.
• Understanding practice patterns is crucial for workforce planning and patient care.
• Billing data offers insights into physician practice behaviors.

Purpose of the Study:

• To define longitudinal practice phenotypes within the IR workforce.
• To analyze the association of these phenotypes with procedural complexity and workforce growth.
• To examine trends in procedural sedation and evaluation and management (E/M) billing.

Main Methods:

• Retrospective analysis of Medicare data (2013-2023).
• Classification of IR physicians into four practice phenotypes based on sedation and E/M billing.
• Assessment of longitudinal workforce trends, sedation billing, and procedure mix.
• Evaluation of associations between practice phenotype and procedural complexity.

Main Results:

• The IR workforce more than doubled between 2013 and 2023.
• Moderate sedation billing increased significantly, especially after 2017.
• The 'Moderate Sedation Only' group became the largest cohort (46.8% in 2023).
• Complex procedures were most common in the 'Both' (sedation and E/M) group.
• Workforce growth was concentrated in physicians performing routine procedures.

Conclusions:

• The IR workforce is stratifying into distinct practice phenotypes.
• Complex IR procedures are predominantly performed by physicians combining clinical integration and procedural sedation.
• Workforce expansion is driven by physicians focused on routine procedural care.
• Comprehensive IR practice is linked to integrated clinical and procedural services.