Practice management The E&M service produces, on average, 15 new consults for inpatients daily and a large volume of follow-up visits. No IR procedure can be “ordered” in our hospital system; a full consultation is performed on every patient with a dedicated history and physical and with an assessment and plan appropriate to the disease condition. Although we take pride in our technical expertise, many consultations result in plans that involve no procedures.
The office/clinic functions five days a week with each physician having dedicated IR time. We’ve hired scribes to help with documentation in the office/clinic, relieving us of the EMR burden and significantly increasing productivity and patient volumes.
In addition to the patient care aspects of our practice, we are highly involved in many committees and conferences, including a vascular conference, multidisciplinary tumor boards, quality assurance meetings, operations committees, M&M conferences and marketing initiative meetings.
Training Though technically a private practice, we are also academic. Because educating the next generation of interventionalists is one of our biggest goals, we have a longstanding fellowship (soon to be residency) program with medical students on rotation at any given time. We also participate in multiple training courses at the institute including those for peripheral vascular disease, aortic aneurysm management, radial access and radioembolization. We will soon have a training program for irreversible electroporation (IRE) as well.
“Our fellows learn not just how to open an iliac vessel or an SFA but also how to work up the patient, assess the noninvasive testing, look at the imaging and noninvasive tests to synthesize a plan with the patient, and then ultimately go on to treat the patient. We train them to be excellent clinical physicians as well as very good interventionists.”—Dr. Benenati
Every week, practicing physicians call us looking for additional experience in areas we cover. This demand has led to a one-week visiting fellowship that exposes practicing IR physicians to direct case observation, supplemented by didactic clinical conference sessions and informal discussions.
Challenges Current challenges facing the practice include pressure for RVU production and a widening gap of understanding between the RVU- driven diagnostic division and the clinical division. Our clinical division may be growing in volume but it also has patient responsibilities, teaching components and academic obligations that may not be completely appreciated by nonclinical partners. In addition, the physicians in the clinical division are not only active participants but also leaders of multiple hospital committees. Decreasing reimbursement for some minimally invasive procedures has had an impact.
Like many other IR practices, we are not immune to competition and face constant turf issues with cardiology, neurosurgery, and surgeons and interventionalists outside of our group in the outpatient setting.
Marketing We market our practice in many ways:
• Local public TV (PBS) appearances on topics including PAD, CLI, fibroids, varicoceles, IO and spine interventions
• Dinners with referring physicians and trips to physician offices
• A regularly updated website
• Participation in health system–related committees, such as credentialing, QA, risk management, CME, PERT, CLI, clinical research, aneurysm, and various cancer center committees
• Marketing to administrators is a key component, especially since most other specialties offering vascular and endovascular services (cardiology, cardiac surgery) are employed by the health system.
Growth and future directions Miami Cardiac & Vascular Institute has recently undergone a 120-million- dollar expansion. Walking into our interventional suites, one sees that all of our labs have large glass windows that are open to all. According to Dr. Katzen, “It was built as an architectural expression of the philosophy of the institute: transparency. The benefits to patient care are that all physicians involved in invasive therapy are working side by side. Literally. We don’t have barriers. If there is a problem with a patient, we have incredible human professional resources here to help solve the problem.”
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