We postulate time commitment and reimbursement versus frequency is a disincentive to provision of necessary pulmonary procedures. We analyzed our preferred model for procedure provision via a dedicated interventional pulmonology (ip) service for impact on overall practice, patient access and efficiency in our large single specialty private setting.
At the American Association of Bronchology meeting at CHEST 2004 and 2008, we anonymously surveyed attendees to estimate time spent in evaluation and management (E/M) and ip level procedures, excluding basic diagnostic bronchoscopies. Data analyzed for practice type (academic vs. private), years in practice, and training status for representative CPT codes and converted to reimbursement/60 minutes. Pulmonary procedure (non-ICU, non-sleep), and E/M volume, revenue changes, and code frequency where analyzed for our practice year over year (‘07–‘08).
2004, 2008 response rates: 30%, 33%. Majority were academic attendings. Average years in practice, 8.88, 7.57. Reimbursement/60 min $237.33 (advanced procedures) and 193.37 (E/M). For the practice ’07–’08: E/M accounted for 51% and 52% of revenue; pulmonary procedures 2.7% and 3.1%, respectively. Noted increases (%): total revenue 2, practice volume 4, E/M volume (revenue) 4.8(7.4) and procedure volume (revenue) 42 (23).
Contrary to perceptions, current reimbursement patterns do not incentivize pulmonary procedures as they are not time or cost efficient considering frequency. High level procedures pay more per hour but, with low frequency relative to E/M, are not the dominant revenue source. This may lead pulmonologists to unintentionally limit provision and access to necessary procedures. Our model of a dedicated ip service efficiently overcomes these obstacles. Other practitioners are freed to grow E/M volume to maintain access and revenue in the face of decreased reimbursements. Procedure provision and access can grow in support to the benefit of patient access and practice viability.
A dedicated ip program within a large practice or accessible to multiple small practices is the most efficient manner to provide necessary pulmonary procedures and improve patient access in an environment that disincentivizes such services.
Sara Greenhill, No Financial Disclosure Information; No Product/Research Disclosure Information