Reimagining Interventional Radiology: A Path to Lower Costs and Better Cancer Care

In this podcast, Dr. Joshua Dowell, a private practice pioneer in radiology care, explores the future state of interventional radiology and why moving these services away from hospital‑based setting represents a critical opportunity for the healthcare system. He discusses how alternative care models can meaningfully reduce costs, lower patient risk, and improve quality—particularly in cancer care. The conversation highlights how rethinking site‑of‑care decisions in interventional radiology can unlock a more sustainable cost structure while delivering better outcomes for patients.

After listening to this podcast, participants will be able to:

• Explain the potential impact of shifting interventional radiology away from hospital‑based services, including implications for cost, access, and care delivery.
• Understand how alternative interventional radiology models can improve patient care and reduce risk, particularly through more appropriate care settings.
• Identify the drivers of improved cost structure when interventional radiology services move outside of traditional hospital environments.
• Recognize the path forward for improving cancer care through innovative interventional radiology delivery models.

Transcript

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Welcome to The Pulse in 15, a series for busy professionals who want to stay on top of what's shaping employee benefits. This 15-minute version of our podcast series delivers what The Pulse is

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insights from leading experts across health, pharmacy and research institutions, with the clarity and straight answers you need in a fast-moving space. I'm Mary Delaney, Managing Partner of Vital Incite an Alera Group Company. As you know, I love to talk to people who are creating sustainable change in healthcare. So today we will explore interventional radiology. This specialty sits at the intersection of innovation, costs, and patient outcomes. And where that care is delivered matters more than ever. Dr. Joshua Dowell, a private practice pioneer in radiology care, joins us today to explore the future state of interventional radiology, and why moving these services beyond hospital-based settings could dramatically reduce costs, lower patient risk, and improve quality, especially in cancer care. We'll discuss how rethinking site-of-care decisions can unlock a more sustainable healthcare model, while delivering better outcomes for patients. Dr. Dowell, thank you for joining us today. Thanks, Mary, for having me on the podcast to discuss how we can make high-level medical procedures more affordable and accessible through outpatient settings. That's what everybody wants to hear about. So with that, why don't we start off and you can explain to us what the heck interventional radiology is? Yeah, good question. So interventional radiology, which is also known as IR, is a subspecialty of radiology that uses imaging guidance, so such as x-ray, ultrasound, MRI, CT, to perform minimally invasive procedures to diagnose and to treat medical problems. And so these range from biopsies to vascular treatments to precise cancer therapies. And because these procedures typically require only a small needle stick, they offer shorter recovery times and lower complication rates compared to traditional surgery. So when you decided to shift interventional radiology oncology care from hospital-based settings to an office-based model, what problem were you trying to solve for and what changed once you moved the procedures to outpatient? Yeah, good question. So my past has historically always been hospital-based and our profession has always been hospital-based. And a few years ago we thought, can we do many of these procedures outpatient, and outside of the hospital? And what we tried to do was to aim to solve the structural inefficiencies. It wasn't about trying to move to a different location. We know that hospitals are essential for emergent care, but they're really slow and expensive for outpatient procedures due to high facility fees and administrative overhead. So when we started, we literally sat down and we wrote out the problems we face delivering IR care in the hospital. And by moving to an office-based model, we gained control of the workflow, providing faster, more cost-effective and community-based care. And what surprised me most was how dramatically patient satisfaction improved when we integrated clinic, the procedure, and the post-procedural care all into a single location outside the hospital. So people always fear, or I guess have this impression that anything related to cancer should be closely jointed with a hospital. How did you have the comfort in knowing that you could start to do this in a different location? So, we had to think critically about what patients can be done in a hospital setting and which ones can be done outpatient. And so you're correct that many of the procedures we do are historically ones that would be done in the hospital setting. And, but we also know too that hospitals create significant delays in care. And for patients that have cancer particularly, the goal is to try to get these patients in quicker so they can expedite their care and start their chemotherapy and start their process toward recovery. And so we looked at, in the hospital setting, where are those bottlenecks at? And we found that really the bottlenecks are in patient transportation and bed management. That's what slows down the process of getting these outpatients in the door to get the procedures done. And so while case selection is critical, and ICU-level care needs to still be in the hospital, many procedures can be diverted to outpatient labs, particularly those we do for cancer patients. And this allows the hospitals to focus on the high-acuity patients, but then provide the less intimidating, more efficient environment for patients that are particularly like cancer patients and need an outpatient procedure done. And would you say there are other benefits like, is time of treatment, or exposure to infections, other things to be seen from this shift? Oh, most definitely. And so you kind of initially discussed it at the very beginning of our discussion, which was the cost savings are significant. But in addition to that, we see a lot of other benefits too from doing it - from the standpoint of easier scheduling, faster turnaround times to initiate their chemotherapy, and a much better patient overall experience when doing it this way. And so in terms of the cost, you know, the cost savings are significant. And it's because there are differences in payers and regions. And so it's hard to really give definitive examples of what that really looks like. But there are common themes in the cost savings that we have in the outpatient setting for IR for these type of procedures. And the clear cost differences show up in procedures that are high volume, standardized, elective, safe, without hospital backup. So these are many of the procedures we do for cancer patients, such as a chest port for chemotherapy, a biopsy done for these patients. And actually as we went down further down the road, we discovered many liver-directed precise therapies that we do for patients can be done in the outpatient setting as well. And that's because the hospital facility fees become saved. There's also those large markups on devices, too. When you look at patients overall, like for many procedures we do, that cost savings could be 50% less when we do it in the outpatient setting compared to when we do it in the hospital. But beyond that, we found that actually patients were getting benefits from easier scheduling. It's easier for a referring office to refer the patient. You don't have to go through a centralized scheduling system to get it scheduled. It's a faster turnaround time for patients when they walk in the door to when they actually have to go home that same day. For some procedures, that might be hours faster for the patient. And they don't have to try to navigate geographically to find where the parking garage is to get up to do the procedure. And that in turn turns into a much better patient overall experience with trying to do it this model. Let's pause to thank our sponsor. his podcast is brought to you by Alera Group. Vital Incite is part of Alera Group, an independent financial services firm offering comprehensive property and casualty insurance, employee benefits, wealth services, and retirement plan solutions to clients nationwide. Working collaboratively across specialties and across the country, Alera Group's team of more than 4,600 colleagues offer unique solutions, personalized services, and proactive insights to help ensure each client's business and personal success. For more information, visit aleragroup.com and follow us on LinkedIn. There are very few people like you doing this high-acuity IR this way. You've talked about why this model is so feasible. Do you think this is, you know, are we gonna see much more of this? I always think back to - gosh, I don't know how many years ago now - when we heard that total joints were gonna be outpatient, and now it would be unheard of almost to do an inpatient total joint. How quickly can we expect this to expand so that people have more access to this type of care? Yeah, good question. You're right that early on right now, there's probably only a handful of centers around the country that provide specifically liver-directed therapy, Y90, which is a radioactive bead treatment for cancer care. And we're the first in the Midwest to offer that. I think that that is coming further in the future, meaning that I think many other places are looking to try to grow to provide these services outpatient, out of the hospital. But it does require both hospitals and service providers to come together with aligned incentives to try to provide this model to more patients. And so it's easy to do at the hospital. But I think there's more education for referring groups, as well as for hospitals and for patients; I think the service line will grow in the outpatient setting, and also too what we can provide. Should we not expect that hospitals are going to not want this to happen because it's a lot of revenue that's going to come out of the hospital system? Yeah, I think that it is a change in different incentives, right? And so I think that, but right now, I think across rows, we're beginning to have those discussions with hospitals, too. We're discussing ways that we can integrate this care model - an outpatient office-based lab model for interventional radiology – and align incentives with the hospitals to provide outpatient model to more patients. I mean, the savings in patient satisfaction are real in an outpatient setting. And I think that as we break down these barriers with hospitals and align incentives back toward improving patient care and lowering the cost, I think that's what's most important. And if, you know, correct me if I'm wrong, but we have to have aligned incentives because it is through the hospital system that many people may be diagnosed. So you need to have the hospital be willing to give these options to the patients. Is that correct? Correct. And so many times the patient might be diagnosed in the inpatient setting, but they also may actually come across that more and more in the outpatient setting where they're finding their diagnosis, and then they're getting their biopsies done outpatient, too. And my hope is really in the future of IR that we move toward more of a value-based care model that might prioritize patient satisfaction and cost efficiency, so we can get patients in quicker and get where they need to be, which is getting treated faster. Yeah, everybody's hoping for more value-based, but it's not moving at the pace that we need it into that direction. But employers, because they are the payers, can create that type of model. So in, you know, I know I've heard you speak about even the difference in the cost of a chest port. Can you give me an example, or our audience an example of what a chest port is, and what the cost difference is between the two locations, and why it's so feasible to do this in an outpatient setting? Yeah, a good question. So in our facility, a chest port for chemotherapy, which is a small device which is placed underneath the skin, which has a small catheter goes up in the tip of it, is close in above the heart. And that's the direct route that patients receive their chemotherapy when they get diagnosed with cancer. And many patients that have cancer will have these chest ports placed for that. Interestingly, that may cost $10,000 less when the same provider places a chest port under the same CPT code than when the same provider places that same chest port in the hospital setting. And so in Indianapolis alone, moving chest port placements for chemotherapy to our facility saved the local healthcare system approximately $2.5 million just last year alone, by just doing chest ports for chemotherapy. So I think there's great cost savings for patients and for employers and payers by doing a more cost-effective approach- an outpatient approach - for patients. What came along with that actually was improved patient satisfaction. So whereas in the hospital these patients may have to park and walk in and the pre-procedural time may be a couple hours before the procedure, there may be delays because of the acuity of the patients being treated in the hospital. When doing an outpatient, they arrive a half hour before, they leave a half hour afterwards. And so the turnaround time is much quicker for a patient when they get the procedure done. And so beyond the cost in these, we're finding the patients benefit from easier scheduling. You know, it's within 48 hours of when getting the order, a faster turnaround time to initiate their chemotherapy, and overall a much better overall experience for the patient. All incredible, and all because you are willing to do something different that we're starting to understand the opportunity here. Do you have any advice for employers who are listening to this and going, you know, I want this, I want this for my people to have better outcomes, and of course for our health plan to also have improved costs. How can they go about directing something like this? I think it's again like we discussed earlier about trying to align incentives with hospitals, trying to identify groups that may be interested in providing these services outside the hospital. And if you're in a location that does have that option, is trying to network and align yourselves with those groups too to try to get that care done. And so I'm always happy to discuss healthcare delivery models. That's where I'm particularly interested in trying to provide faster, easier, better, more cost-efficient care for patients. And I think that when we focus more on the patient, that's what we can accomplish by doing that. And my hope is in the future that as we move forward that there'll be more opportunities like this in the communities around the country that can provide that care. So if you were an employer and talking to the carrier, trying to choose which carrier you want to work with [because that's really where our relationship is; we don't talk to the hospital systems] what kind of questions could you ask to determine if they have considered this or would help redirect care, etc.? Do you have any idea? I would ask if they have transparency with the cost models that are available to them in that area. And if they have outpatient models that would be available in those areas to provide a more cost-effective model for those patients. So meaning that, if there's an ability to get a cost… for instance, when we talked about chest ports, the chest port placement is only a small part of that patient's journey. And oftentimes that may be the only interaction they have with that physician actually, is for the port placement, and maybe the port removal afterwards. That's something that can be done in any network system. So although their oncologist may be within one system, a port placement might have cost benefit to go to a different system for that. And so it's understanding, I think, the costs across different systems to find one that might be the most appropriate for that patient or for that employer to work with. So I know we're running out of time, but there's one question I have to ask you. We have truly identified one of the biggest issues right now is the markup on the infusion drugs. So chemotherapy drugs, etc. When we are learning that many times carriers are paying percentage bill to hospital systems, and that makes it so expensive. In your system, kind of how do you manage, do you have access to all those drugs? And I know you can't answer all of this in a short amount of time, but are there certain treatments that could be done in an outpatient setting to redirect place of care for that? Yeah, good question, too. So, I don't directly work with the medications you're talking about- the drugs you're talking about. I work more…. but how it impacts us is the price of medical devices. And there are some medical devices that are not reimbursed in the outpatient setting, and need to go through a hospital setting for it. There's efforts with some of those medical device companies to try to get codes to be able to bill and be able to be reimbursed for those devices in an outpatient setting as well. And my hope is that they'll be successful in doing so, so we can provide those procedures outpatient as well. Until then, we do have to do those procedures in the hospital, which are billed at a higher rate. And so it does impact us in regards to what medical devices we use sometimes. The nice thing for us is to be able to identify these patients up front. We know which ones would benefit from those devices; we can do those in the hospital rather than the outpatient setting. But I think that that's actually where more impacts me is what medical devices I can use. And if, do I have access to it in an outpatient facility or do I need to go to a hospital to be able to use that? Very good. Well, unfortunately we're out of time. Dr. Dowell, thank you for being a pioneer and moving your field forward in a way that will provide better outcomes for patients and for employers. You're really making a difference. And I hope through this conversation will be motivational for other interventional radiologists to do the same. Thank you so much for joining us today. Oh, thanks for having me. To our audience, I hope today's conversation has given you a clear real-world perspective on how benefits strategies can drive outcomes that are better both for the people and for organizations. The Pulse is brought to you by Alera Group. Alera Group is an independent financial services firm offering comprehensive property and casualty insurance, employee benefits, wealth services, and retirement plan solutions to clients nationwide. For more information, visit AleraGroup.com and follow us on LinkedIn. I'm Mary Delaney. Thanks for listening.