Population health outcomes studies provide evidence of value in IR care


In its 2016 Quality Strategy Overview, the Centers for Medicare and Medicaid Services (CMS) stated their plan to link 50 percent of total payments and 90 percent of physician payments with quality or value by 2018.1


Mandated by the Patient Protection and Affordable


Care Act, the National Quality Strategy (NQS) is led by the Agency for Healthcare Research and Quality on behalf of the U.S. Department of Health and Human Services (HHS).2


practices’ and hospitals’ bottom lines and heavily influences the policies adopted by private insurance companies. In the same strategy statement, CMS reiterated the NQS’ three aims. Designed to guide and assess local, state and national efforts to improve health and the quality of health care, the aims are:


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• Better care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.


• Healthy people/healthy communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and environmental determinants of health in addition to delivering higher- quality care.


• Affordable care: Reduce the cost of quality health care for individuals, families, employers and government.


As interventional radiologists, we know the value of our minimally invasive targeted therapies: we see it every day in the lives of our patients. And we know our safe, efficient and effective care is a foundation of any modern hospital. SIR and SIR Foundation have long practiced the art and science of raising awareness of the quality of our care. As the entire health care economy shifts toward quality-based reimbursement, the need and the opportunity to highlight interventional radiology’s crucial role in creating this value have never been greater.


30 IR QUARTERLY | SPRING 2016


ar from a public health talking point, the National Quality Strategy directly informs reimbursement policy by CMS.1


By far the largest payer in the country, CMS policy in turn directly impacts physician


While clinical trials proving the efficacy of surgical or interventional management are notoriously expensive and difficult to conduct, the science of health policy research, in combination with a changing national public heath agenda, has enabled a minor revolution in the way value in health care is assessed. Advanced statistical methods and ever-expanding computing power have ushered in an era of big-data in observational research. At significantly lower cost, examination of large medical claims or registry datasets is providing insight into best practices based on real-world information that was not previously available by way of traditional clinical trials.


Over the last several years, under the leadership of Jeremy Durack, MD, MS, Michael Brunner, MD, FSIR, and Sharon Kwan, MD, the Comparative Effectiveness Subcommittee of SIR Foundation’s Quality and Outcomes Division has supported a series of population studies comparing image-guided minimally invasive therapies, typically provided by interventional radiologists, with open or laparoscopic surgical alternatives.3–5 Findings from our most recent work, “Percutaneous ablation versus surgery for small renal cancers: A population-based analysis,” will be presented at the upcoming SIR 2016 Annual Scientific Meeting in Vancouver, British Columbia (April 2–7).


With support from SIR Foundation and the Association of University Radiologists,* we compared mid-term survival and rates of complications between percutaneous ablation (PA), partial nephrectomy (PN) and radical nephrectomy (RN) for older patients with small renal cancers. Creating propensity-score matched cohorts from the SEER-Medicare


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