Interventional Oncology:Interventional Oncology:Developing the model in Developing the model in private practiceprivate practice

Interventional Oncology:Interventional Oncology:Developing the model in Developing the model in private practiceprivate practice

David Liu, MDDavid Liu, MDInterventional OncologyInterventional OncologyAngio/Interventional SectionAngio/Interventional SectionInland Imaging, LLCInland Imaging, LLCSpokane, WashingtonSpokane, Washingtondliu@inland-imaging.comdliu@inland-imaging.com

Interventional Radiology:Interventional Radiology:Endless Potential To Cure….Endless Potential To Cure….

Well…maybe not Well…maybe not endless….endless….

Is IO a Feasible Direction for IRIs IO a Feasible Direction for IRIn The Private Practice Realm?In The Private Practice Realm?

StrengthStrength We understand and do the imaging We understand and do the imaging Expertise in multimodality therapyExpertise in multimodality therapy Technical abilitiesTechnical abilities

WeaknessWeakness Lack of active participation in managementLack of active participation in management Under utilization of oncology based proceduresUnder utilization of oncology based procedures Our literature is evolving, however will not Our literature is evolving, however will not

compare to pharmaceutical driven studiescompare to pharmaceutical driven studies

OpportunityOpportunity Chance to develop skills and understanding of Chance to develop skills and understanding of

disease processdisease process No competing specialists; no one with the skill No competing specialists; no one with the skill

sets that we havesets that we have Complementary to current paradigmsComplementary to current paradigms

ThreatThreat Bottom feeding; diluting responseBottom feeding; diluting response Perception that we are a disruptive technologyPerception that we are a disruptive technology Federal regulatory issuesFederal regulatory issues Perceived turf issuesPerceived turf issues

Depth of PracticeDepth of Practice

ProceduralistProceduralist

EducatorEducator

ClinicianClinician

ResearchResearch

Show UpShow Up

TumorTumorBoardBoard

ClinicClinic

ActiveActive

Passive

Active

OverviewOverview

Creating the Service LineCreating the Service Line

Establishing the ClinicEstablishing the Clinic

The ClinicianThe Clinician

Metrics of SuccessMetrics of Success

Creating the Service LineCreating the Service Line

Technical & AdministrativeTechnical & Administrative Infrastructure for Infrastructure for one stop shopone stop shop Ensure time off for tumor boardEnsure time off for tumor board

Pitfalls & PearlsPitfalls & Pearls Not thinking the logistics throughNot thinking the logistics through Inconsistency in serviceInconsistency in service Tumor boardTumor board attendance is key attendance is key Biopsies and central access may be starting Biopsies and central access may be starting

pointspoints Passive education and collaborationPassive education and collaboration

Practice Patterns: Tumor Practice Patterns: Tumor BoardBoard

Opportunity to provide expertise in Opportunity to provide expertise in imaging, diagnosis, staging, and imaging, diagnosis, staging, and localregional therapylocalregional therapy

Promote all of radiologyPromote all of radiology Dovetails well with referrals to clinicDovetails well with referrals to clinic Establish reputation in communityEstablish reputation in community Without presence, there will be no Without presence, there will be no

referralreferral

Establish the ClinicEstablish the ClinicTechnical & AdministrativeTechnical & Administrative

Physical space (clinic, filing)Physical space (clinic, filing) Dedicated time to see patientsDedicated time to see patients Telephone numberTelephone number E&M coding process/Assistance (one person)E&M coding process/Assistance (one person)

Pitfalls & PearlsPitfalls & Pearls Send intake and h&p forms prior to encounterSend intake and h&p forms prior to encounter Discuss and review prior to consultationDiscuss and review prior to consultation Follow up clinic and letter Follow up clinic and letter Work with an NP or a PAWork with an NP or a PA Consistency in your rationaleConsistency in your rationale Match your clinic day with a Match your clinic day with a collaborating specialtycollaborating specialty

Collaborative effortsCollaborative efforts

Work with referring physician, but do Work with referring physician, but do not bog them down with the detailsnot bog them down with the details

Make it less work for your colleagues to Make it less work for your colleagues to refer a patient to yourefer a patient to you

Streamline the review process through Streamline the review process through participation in tumor boardsparticipation in tumor boards

The ClinicianThe Clinician

Technical & AdministrativeTechnical & Administrative Be prepared to deal with patientsBe prepared to deal with patients Ensure outpatient procedures are scheduledEnsure outpatient procedures are scheduled Dedicate clinical time: dictations, filing and accessDedicate clinical time: dictations, filing and access

Pitfalls & PearlsPitfalls & Pearls Call coverageCall coverage Try to avoid coersion from patients and cliniciansTry to avoid coersion from patients and clinicians If there is not enough information to make a clinical If there is not enough information to make a clinical

judgment; investigate further (previous studies, labs, judgment; investigate further (previous studies, labs, imaging, biopsy)imaging, biopsy)

Round on your patientsRound on your patients Call the primary referring physician Call the primary referring physician Do not be afraid to Do not be afraid to refer to another specialistrefer to another specialist

Patterns: Referral ReciprocityPatterns: Referral Reciprocity

Multidisciplinary/Multimodality model Multidisciplinary/Multimodality model establish referral patternsestablish referral patterns

Self referral patients may require surgical or Self referral patients may require surgical or medical consultation, but start with an medical consultation, but start with an E&ME&M

Team approach can help with Team approach can help with preauthorization preauthorization

Pitfalls:Pitfalls:Getting In Over Your HeadGetting In Over Your Head

Discuss prior to treatment; Discuss prior to treatment; you do not want to be you do not want to be meeting the primary meeting the primary oncologist for the first time oncologist for the first time with a complicationwith a complication

Avoid becoming the Avoid becoming the primary oncologist, primary oncologist, maintain your highly maintain your highly specialized rolespecialized role

Use your facilities: Use your facilities: hospitalists, pharmacy, hospitalists, pharmacy, discharge plannersdischarge planners

Metrics of SuccessMetrics of SuccessTechnical & AdministrativeTechnical & Administrative

Productivity of service line may have long lag timeProductivity of service line may have long lag time Establish measures with hospital administrationEstablish measures with hospital administration Ensure the halo effect is incorporated into Ensure the halo effect is incorporated into

financialsfinancials Invest the time to share your vision with your DI Invest the time to share your vision with your DI

colleaguescolleaguesPitfalls & PearlsPitfalls & Pearls

Watch for automatic DRG conversionWatch for automatic DRG conversion Be cautioned about marketing…..Be cautioned about marketing….. Establish metrics prior to implementationEstablish metrics prior to implementation Passive promotionPassive promotion Participation in studies promote your serviceParticipation in studies promote your service Ortho, CV & oncology are part of hospital plansOrtho, CV & oncology are part of hospital plans

How I Would/Am Do(ing) It:How I Would/Am Do(ing) It:

Start with understanding the literatureStart with understanding the literature

Attendance at tumor board: GI & LungAttendance at tumor board: GI & Lung

Suggest procedures as indications ariseSuggest procedures as indications arise

Discussion with administrationDiscussion with administration

Begin clinic and promote at tumor Begin clinic and promote at tumor boardboard

Develop collaborations with disciplinesDevelop collaborations with disciplines

Provide a method for cross referralsProvide a method for cross referrals

Work towards a multidisciplinary clinicWork towards a multidisciplinary clinic

Final ThoughtsFinal ThoughtsOffer a service, not a procedureOffer a service, not a procedureImperative to Imperative to play a roleplay a role in clinical cancer care in clinical cancer careEducateEducate clinicians while providing clinicians while providing black box serviceblack box serviceEnsure that your Ensure that your group is on board and supportivegroup is on board and supportiveCritical path to success over the next 5 yearsCritical path to success over the next 5 years

1a. Develop mechanism to sustain interdisciplinary 1a. Develop mechanism to sustain interdisciplinary collaboration….collaboration….

SIR Interdiscp Consensus Panel 2004

‘…‘…similar and coequal to radiation oncology, surgical oncology similar and coequal to radiation oncology, surgical oncology and medical oncology…’and medical oncology…’

SIR IO Taskforce JVIR 2005

Be adjunctive, not disruptiveBe adjunctive, not disruptive

Interventional Oncology:Interventional Oncology:Developing the model in Developing the model in private practiceprivate practice

Interventional Oncology:Interventional Oncology:Developing the model in Developing the model in private practiceprivate practice

David Liu, MDDavid Liu, MDInterventional OncologyInterventional OncologyAngio/Interventional SectionAngio/Interventional SectionInland Imaging, LLCInland Imaging, LLCSpokane, WashingtonSpokane, Washingtondliu@inland-imaging.comdliu@inland-imaging.com