Central venous procedures--traditionally the domain of surgeons and anesthesiologists--increasingly are being performed by radiologists, according to a Harvey L. Neiman Health Policy Institute study published online in the Journal of the American College of Radiology.
In the article, the researchers examined Medicare claims data from 1992 to 2011 for procedures involving central venous catheters and long-term central venous medical devices. They determined that in those two decades, radiology increased from 0.4 percent in 1992 to 32.6 percent in 2011 as the dominant provider group for temporary central venous catheters, exceeding anesthesiology (which decreased from 37 percent to 22 percent) and surgery (which decreased from 30.4 percent to 11.7 percent).
While surgery continues to dominate in the placement and explanation of long-term central venous medical devices (50.4 percent and 47.7 percent), radiology's role has "grown enormously" from 0.7 percent to 37.6 percent and 0.2 percent to 28.6 percent respectively.
According to the authors, the inpatient hospital remains the primary site for temporary central venous access procedures, while the placement of long-term central venous access devices increasingly has shifted from the inpatient to hospital outpatient setting. "In all hospital settings combined, radiologists place approximately half of all tunneled catheters and three-quarters [of] all peripherally inserted central catheters," the authors said.
"This research should prompt health system leaders and administrators to re-evaluate the role of radiology departments in hospitals," Neiman Institute CEO and FierceHealthIT Editorial Advisory Board member Richard Duszak, M.D., the paper's lead author, said in a statement. "We're seeing more radiology practices being displaced from long-standing hospital relationships because administrators think they can outsource all of their radiology needs. National data tells us, though, that radiologists are being relied upon with increasing frequency in the hospital setting to perform central venous procedures."
Danny R. Hughes, Ph.D., another of the study's authors, said that the study "verifies a significant transition in the way central venous procedures are being handled in U.S. hospitals.
"Surgeons are stepping away from these functions and radiologists are filling the need," Hughes said. "This tells us there is a direct tie between health policy and hospital administration decisions concerning radiology and patient access to these critical healthcare services."