Launching a robust interventional radiology telemedicine service amid the pandemic
University of Texas MD Anderson Cancer Center has developed a robust telemedicine program to maintain its interventional radiology services during the pandemic, imaging leaders detailed Tuesday.
Before COVID-19, the Houston-based institution’s IR program saw upward of 7,500 patients annually but had no formal means to connect remotely, other than a few nonbillable phone calls each month.
However, as the public health crisis took hold, MD Anderson launched a concerted effort to minimize the number of cancer patients visiting its facilities. After cutting off in-person clinic visits in March 2020, the institution logged more than 10,000 telemedicine encounters (68%), before transitioning back to regular visits in April 2021.
Analyzing the results, MD Anderson researchers found some successes but also reimbursement-related concerns that shape the program’s future, experts wrote in JACR.
“Our findings demonstrate the telemedicine services can be delivered effectively for interventional radiology patients, but challenges remain with the widespread implementation of synchronous video visits,” Colin McCarthy, MD, with University of Texas MD Anderson Cancer Center’s Department of Interventional Radiology, and colleagues concluded. “Further work is required to determine the potential implementation barriers to increasing the proportion of telemedicine encounters using video technology, and to monitor changes in federal and state requirements for the provision of telemedicine services.”
For their study, McCarthy and colleagues reviewed evaluation and management (E&M) and reimbursement data spanning from September 2019 to May 2021. MD Anderson offered audio-only, telephone ambulatory IR clinic encounters for 11 weeks before also introducing video visits following more than two months of development. IR clinic visits typically include discussing the risks and benefits of image-guided therapy, along with addressing any post-procedure care, the authors noted.
All told, MD Anderson provided telehealth IR services to patients across 46 states and the District of Columbia. But due to billing and licensing requirements, the provision and type of services depended on whether the patient and provider shared the same geography. About 73% of the virtual visits included a patient with a home address in the same state as the institution.
Before COVID, MD Anderson averaged 629 ambulatory E&M encounters in interventional radiology per month. That fell to 435 in March 2020 when the pandemic took hold and two total visits in April. After the licensing and regulatory requirements were in place, telehealth IR encounters increased to 595 by June, 629 in July and 537 by August, representing 85%-99% of pre-pandemic volumes. When both audio and video were available, the vast majority of patients (77%) stuck to the telephone-only option. By the time MD Anderson started relaunching in-person visits, it averaged more than 763 IR clinic encounters per month, up 21% compared to before the public health crisis.
But despite promising volume totals, reimbursements from the effort fell short, McCarthy et al. noted. Professional evaluation and management revenue between June 2020 to May 2021 was below peak pre-pandemic levels by an average of about 38%. And physician-billed monthly E&M visits averaged about 38 before the COVID crisis, with a 57% drop during the 14-month study period, down to 16 per month. About 86% of interventional radiology clinic encounters had associated charges submitted for reimbursement prior to the pandemic, falling to 69% with the implementation of telehealth.
“Based on provider and patient experiences to date, it is clear that telemedicine will almost certainly play an increasing role in healthcare delivery during the pandemic and beyond,” the authors advised. “Many long-term challenges remain in the form of regulations, licensing and reimbursement.”
You can read more in the open-access article, published in the Journal of the American College of Radiology, here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.