A Descriptive Revenue Analysis of a Wound-center IR Collaboration To Treat Lower Extremity Venous Ulcers
How much revenue will be created by treating patients with venous leg ulcers in a joint collaboration between a wound care center and IR?
This joint venture between IR and wound care clinic generated revenue not only through procedures but also E&M, and imaging.
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Retrospective review of 36 venous ulcer patients
Academic center, New York University School of Medicine
Figure 3. Relative wRVU contribution to total wRVU by category. (b) Relative revenue contribution by category. wRVU=workrelative value units.
Treatment of venous leg ulcers (VLU) requires a collaborative effort with a wound care center. The authors studied the revenue generated by developing a collaborative effort with the wound care center. Patients referred to IR were patients with previous stents, filters or what was considered “more difficult venous disease”. Patients were initially evaluated in a dedicated outpatient facility. Follow up was usually at 3 and 6 months, at which time further intervention or imaging was considered.
36 patients were included in the study, 15 patients underwent (16 procedures), 21 were evaluated but did not undergo an intervention. Sources of revenue included E&M visits (initial evaluation and follow up, diagnostic imaging (before and after procedure) and procedures. CPT codes were used to account for E&M visits, diagnostic studies and procedures. The professional component (wRVUs) was calculated based on the E&M visits, diagnostic imaging and procerus.
The authors report 70 total clinic visits (36 initial, 34 follow up) and 3.6 new consultations per month. 31 pre-procedural imaging studies were ordered and procedural patients required 11 post-procedure studies. The total wRVU generated from this venture was 518.15, 24% wRVUS were due to E&M, 10% from diagnostic studies and 66% from procedures. 86% of wRVUs were due to procedure patients. This translated to a total revenue of $37,522 over 10 months, 58% was due to procedures, 23% to E&M and 28% to diagnostic imaging. Intervention patents accounted for 80% of the revenue, and on average the individual patient revenue was $624 (range $110-$3,077).
The findings of the study support the concept that clinical involvement is not only good for patient care, but can also result in revenue for an IR practice. The authors use several examples to show how E&M codes provide significant revenue to other specialties (20% of revenue for vascular surgery and 40% for cardiology). The authors highlight that the revenue was derived from CMS rates and therefore it underestimates revenue by not taking into account private payers. The study also references data from an IVC filter clinic that generated $712 per patient, which was more than the average revenue per patient in the joint wound care clinic collaboration ($624), but less than the median intervention patient revenue ($1,931) and less than the pathway per patient revenue ($1,042). Overall an IVC filter clinic will lead to $22,775 over 10 months (compared to the $35,000 in the joint venture).
The authors identify that this study is limited by data from a single tertiary center, as well as lack of data for actual collections and charges, technical procedural revenue and hospital procedural revenue.
In conclusion, the authors find that a joint wound care-IR collaboration in the care of VLU patients may lead to substantial revenue from not only procedures but also E&M and diagnostic imaging.
The authors provide more evidence that IR clinic and IR clinical involvement, is not only good medical practice, but may also become an important source of revenue. The authors provide examples on how similar specialties (Vascular surgery and Cardiology) derive significant revenue from E&M codes. It is clear that patients that undergo procedures, lead to a higher revenue, but the revenue generated from non-procedure patients is not negligible (20% of total revenue). Joint ventures with practices that have patients in common (wound clinic, podiatry) will lead not only to better clinical care and better outcomes, but potentially more referrals as well as creating other collaborative efforts (diabetic foot wounds, critical limb ischemia, etc).
Carlos J. Guevara, MD, FSIR
Assistant Professor of Radiology and Surgery
Division of Interventional Radiology
Mallinckrodt Institute of Radiology, St Louis, MO