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A model for merging vascular surgery and interventional radiology: clinical and economical implications.

Publication ,  Journal Article
Ouriel, K; Green, RM; Waldman, D; Greenberg, RK; Shortell, CK; Illig, K
Published in: J Vasc Surg
December 1998

BACKGROUND: The traditional separation of vascular surgery and interventional radiology into distinct units is associated with inefficiencies in patient care, practice management, and training. Traditional departmental politics, discrepant clinical backgrounds and philosophies, fear of decreasing remuneration, and basic differences in education, training, and practice have all rendered mergers difficult. METHODS: We have implemented a model that incorporates all the clinical, fiscal, and educational activities of the 2 former entities into a single unit. A 5-physician vascular surgery group, its noninvasive laboratory, and a 3-physician interventional radiology group were unified. The revenue was deposited into a single account from which all the expenses were paid. The net income of the joint unit was apportioned on a predetermined pro rata basis, with scaled percentages for each practitioner. In an effort to separate clinical decision making from economic pressures, the individual physician remuneration was not on the basis of productivity. Clinical volume, gross revenue, and remuneration were compared with the 12-month period that immediately preceded the merger and contrasted to the previous 3-year historical trend (HT). RESULTS: The number of vascular surgical procedures fell after the merger (-9.3%; HT, +4.7%). By contrast, the number of interventional radiology procedures rose (+56.1%; HT, +15.2%), as did the number of noninvasive testing (+9.2%; HT, +3.5%). In concordance with the number of procedures, the gross revenue of vascular surgery fell (-23.7%; HT, +1.1%) and that of interventional radiology rose (+53.5%; HT, +46.0%). The increased efficiencies allowed the total expenses of the 2 units to fall (-13.2%; HT, +7. 5%), and, despite the reduced revenue, the vascular surgeon remuneration was preserved (+0.7%; HT, -3.9%) and the radiology remuneration rose (+22.3%; HT, +8.3%). The merger allowed the vascular surgery fellows to actively participate in 26 interventional cases per month and the interventional radiology fellows to actively participate in 8 open surgical cases per month. CONCLUSION: The merger of vascular surgery and interventional radiology resulted in a decrease in the surgical procedures and revenue, with a corresponding increase in the interventional radiology procedures and revenue. Despite these effects, the physician remuneration increased as a result of the improved efficiencies in practice management and the reduction in expenses. The merger of the 2 units excludes the economic pressures from clinical decision making and appears to be warranted on the basis of the fiscal and educational benefits that are achieved.

Duke Scholars

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Published In

J Vasc Surg

DOI

ISSN

0741-5214

Publication Date

December 1998

Volume

28

Issue

6

Start / End Page

1006 / 1010

Location

United States

Related Subject Headings

  • Vascular Surgical Procedures
  • Specialties, Surgical
  • Radiology, Interventional
  • Practice Management, Medical
  • Interprofessional Relations
  • Income
  • Humans
  • Hospital Departments
  • Cardiovascular System & Hematology
  • 3202 Clinical sciences
 

Citation

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Ouriel, K., Green, R. M., Waldman, D., Greenberg, R. K., Shortell, C. K., & Illig, K. (1998). A model for merging vascular surgery and interventional radiology: clinical and economical implications. J Vasc Surg, 28(6), 1006–1010. https://doi.org/10.1016/s0741-5214(98)70026-6
Ouriel, K., R. M. Green, D. Waldman, R. K. Greenberg, C. K. Shortell, and K. Illig. “A model for merging vascular surgery and interventional radiology: clinical and economical implications.J Vasc Surg 28, no. 6 (December 1998): 1006–10. https://doi.org/10.1016/s0741-5214(98)70026-6.
Ouriel K, Green RM, Waldman D, Greenberg RK, Shortell CK, Illig K. A model for merging vascular surgery and interventional radiology: clinical and economical implications. J Vasc Surg. 1998 Dec;28(6):1006–10.
Ouriel, K., et al. “A model for merging vascular surgery and interventional radiology: clinical and economical implications.J Vasc Surg, vol. 28, no. 6, Dec. 1998, pp. 1006–10. Pubmed, doi:10.1016/s0741-5214(98)70026-6.
Ouriel K, Green RM, Waldman D, Greenberg RK, Shortell CK, Illig K. A model for merging vascular surgery and interventional radiology: clinical and economical implications. J Vasc Surg. 1998 Dec;28(6):1006–1010.
Journal cover image

Published In

J Vasc Surg

DOI

ISSN

0741-5214

Publication Date

December 1998

Volume

28

Issue

6

Start / End Page

1006 / 1010

Location

United States

Related Subject Headings

  • Vascular Surgical Procedures
  • Specialties, Surgical
  • Radiology, Interventional
  • Practice Management, Medical
  • Interprofessional Relations
  • Income
  • Humans
  • Hospital Departments
  • Cardiovascular System & Hematology
  • 3202 Clinical sciences