key: cord-0972813-ewnv2qz7
authors: Patel, Mikin V.; Ahmed, Osman; Hennemeyer, Charles; Hatchett, Scott; Sacramento, Michelle; Funaki, Brian
title: Interventional Radiology is an operational and financial hedge for hospitals during COVID-19
date: 2020-07-23
journal: J Vasc Interv Radiol
DOI: 10.1016/j.jvir.2020.07.019
sha: 4c8b87b6bbc01400094d520b52804d2ea4a71722
doc_id: 972813
cord_uid: ewnv2qz7

nan

The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented operational and financial challenges for US health systems. The US Centers for Disease Control and Prevention directed healthcare facilities to reduce any potential negative impacts on hospital bed capacity and the Centers for Medicare & Medicaid Services followed with the recommendation that all elective surgeries, nonessential medical, surgical, and dental procedures be delayed during the pandemic (1,2). At the same time, the American Hospital Association estimated a sharp reduction in hospital procedures with yearover-year decrease in inpatient and outpatient services of 13% and an estimated loss of $161.4 billion in revenues from March to June 2020 (3).

Under normal circumstances, Interventional Radiology (IR) efficiently cares for both inpatients and outpatients. In response to the COVID-19 pandemic, IR has taken a more prominent role in the hospital, accounting for an increased share of both procedural volumes and gross charges at two academic medical centers, the first with a total of 894 beds in Tucson, Arizona and the second with 811 beds in Chicago, Illinois. This trend countered the observed, and notably opposite, trend towards a relative decrease in contribution from other prominent procedural services (surgery, cardiac catheterization lab, and endoscopy).

This report used aggregated departmental data from the institutions studied and was exempt from Institutional Review Board approval. At both medical centers, procedural volumes across the hospital decreased year-over-year (35% and 69%, respectively) in April 2020. However, IR procedural volumes decreased by a much smaller amount (22% and 35%, respectively). Meanwhile, procedural volumes in surgery, cardiac catheterization lab, and endoscopy decreased by a much larger proportion (Table 1) . At the medical center in Tucson, gross procedural charges for the hospital decreased 40% year-over-year in April 2020 but IR charges had only decreased 20% (Table 2 ).

In 2019, the majority of IR procedural volume at both medical centers was comprised of outpatients while most surgery and cath lab procedures (56% and 60%, respectively) were performed on inpatients.

The COVID-19 pandemic, however, led to suspension of non-essential procedures and diverted resources towards inpatient care. Paradoxically, IR pivoted from a predominantly outpatient-based practice to a service focused on hospital inpatients while services that were predominantly treating inpatients in 2019 decreased their role (Fig 1) .

The data above demonstrate that, while other procedural services such as surgery, cardiac catheterization lab, and endoscopy have suffered decreased procedural volume and charges, IR has filled the void. The resultant increased disparity in work performed and charges generated should be recognized by hospital administration as a source of procedural revenue that is relatively spared.

Furthermore, the work performed by IR during the pandemic likely provides value by contributing to patient discharges and length of stay metrics, however the authors acknowledge this would be difficult to quantify.

IR's adaptation to the operational shocks of the COVID-19 pandemic was largely the result of two factors: efficiency in reconfiguring workflows and availability to treat patients. At both medical centers included in this report, IR departments promptly prepared for handling of COVID-19 patients by adding negative pressure air handling for IR suites, clearly assigning duties and personal protective equipment for staff, and establishing clear protocols on potentially aerosolizing procedures requiring extra precautions. Notably, these changes took effect in IR before they were implemented in the operating rooms. This finding has also been noted at other large medical center where IR departments have rapidly reconfigured workflows to accommodate COVID-19 patients (4) . Secondly, the interventional radiologists at both institutions noted an increased number of consult requests for procedures which are traditionally areas of considerable overlap in scope of practice (central venous access, gastrostomy, nephrostomies, biopsies, and venous thromboembolism intervention). In many cases, other procedural services had rejected these consultations for lack of medical urgency and IR was available and ready to treat these patients during the COVID-19 pandemic. Similarly, IR physicians at other institutions have made themselves available to facilitate critical care services with multidisciplinary support (5).

The flexibility and motivation to accommodate the needs of the hospital are arguably core principles of Interventional Radiology which appear to be common across multiple institutions. During times of stress, these strengths allow IR to serve as an operational and financial hedge for ensuring the continued health of critically ill patients and burdened health systems. 

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Hospitals and Health Systems Face Unprecedented Financial Pressures Due to COVID-19

Old Threat, New Enemy: Is Your Interventional Radiology Service Ready for the Coronavirus Disease