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  • IR call coverage at small hospitals

    Posted by mthx9155 on May 3, 2023 at 11:03 am

    How do your groups manage IR call coverage at smaller hospitals that, during day shifts, really only need one IR on-site, but obviously require much more than that for sufficient 24/7/365 IR call coverage? 
     
    I know larger groups that cover multiple hospitals have an IR covering multiple hospitals on call. But what if you don’t have that larger pool of IRs to draw from? 

    lisbef3_453 replied 1 year, 2 months ago 8 Members · 9 Replies
  • 9 Replies
  • reshunho_265

    Member
    May 3, 2023 at 11:38 am

    depends on the hospital. 
    some small hospitals require no procedural coverage, others LP only.  so need rads that can do an lp.
    others very lite ir lp, para thora, maybe some fluoro studies, slightly smaller groups of rads
    then lite ir; abscess drain, nephrostomies maybe a filter plus above, still smaller group, a few general rads plus the ir section
    main hosp ir rads only

    • mildenp

      Member
      May 4, 2023 at 9:41 pm

      If there is just one small hospital then dont offer IR call coverage. Not worth it for the hospital or the radiologist.

      • mwakamiya

        Member
        May 4, 2023 at 11:12 pm

        Offer them what people in the business call “light IR.”
        Paras, thoras, simple biopsies, drainages, occasional tube exchanges, help with the infrequent central venous access, etc., etc.  Most if not all of these are non-emergent. 
        Leave the “real IR” cases to the experts where they also have the backing by subspecialists and a cohesive/well run clinical team with follow-up care in the wards. 
        In terms of costs — IR in hospitals does not make money 99% of the time. It is a service that goes as one of the costs of doing business. 

        • namaalamry_845

          Member
          May 5, 2023 at 2:45 am

          To clarify your comment PirateRad, IR often doesnt make money for a DR group unless they own an outpatient center or vein clinic. They make ALOT of money for the hospital as they capture the technical component.

          • Radscatter

            Member
            May 5, 2023 at 4:02 am

            Agree RadMon… The hospital does well on the tech fee for IR procedures. Some small hospitals are willing to pay a stipend in order to get coverage for the high end life saving procedures (Post partum bleeds, PE, GI bleeds, Stroke, etc). I have been on the recipient end of these stipends, They exist. The hospitals still make money after paying these stipends because they get tech fees and get to keep the patient in their hospital system.
             
            Some hospitals that want to be a high end Labor and Delivery hospital realize that they need emergent embolization backup in order to keep their mortality rates down. Recently there was a physician in Mississippi who went into labor in a small/medium sized city and died from a post partum bleed. The local DR group did not provide emergent IR services at that hospital. Heartbreaking. In a prior job we were averaging 10-20 post partum bleed cases a year. In the US our post partum mortality rates are far worse than Europe. I think IR plays a huge role in keep these rates down. I would not let a family member use a small town hospital without IR backup as their delivery hospital. Too risky.

      • btomba_77

        Member
        May 5, 2023 at 4:08 am

        Quote from wernicke

        If there is just one small hospital then dont offer IR call coverage. Not worth it for the hospital or the radiologist.

        Quote from PirateRad

        Offer them what people in the business call “light IR.”
        Paras, thoras, simple biopsies, drainages, occasional tube exchanges, help with the infrequent central venous access, etc., etc.  Most if not all of these are non-emergent. 
        [b]Leave the “real IR” cases to the experts where they also have the backing by subspecialists and a cohesive/well run clinical team with follow-up care in the wards. [/b]
        In terms of costs — IR in hospitals does not make money 99% of the time. It is a service that goes as one of the costs of doing business. 

        Couple of problems that we see in our far-flung supraregional practice with multiple hospitals, some quite small:
         
        1) The referrer base starts howling if you want to transfer a patient from St. Elsewhere to the Ivory Tower just do do some IR procedure that’s not in the “light IR” package. … and the administrators respond to the squeaky wheels.
         
        2) Fewer and fewer general radiologists have that broad set of described “light IR skills” 
         
        3) Nobody even wants to be the generalist butt-in-chair rad to even set foot in the small hospital, no less stick a needle in something.
         
         

        • Radscatter

          Member
          May 5, 2023 at 7:11 am

          3) Nobody even wants to be the generalist butt-in-chair rad to even set foot in the small hospital, no less stick a needle in something.

          Thats why stipends are the key. There is a number that these small hospitals can pay that will encourage IRs to be willing to take call. I take occasional call at a couple local hospitals that pay a stipend.

          Another thing-Stipends are cheaper than Locums

        • Unknown Member

          Deleted User
          May 5, 2023 at 10:43 am

          Quote from dergon

          Quote from wernicke

          If there is just one small hospital then dont offer IR call coverage. Not worth it for the hospital or the radiologist.

          Quote from PirateRad

          Offer them what people in the business call “light IR.”
          Paras, thoras, simple biopsies, drainages, occasional tube exchanges, help with the infrequent central venous access, etc., etc.  Most if not all of these are non-emergent. 
          [b]Leave the “real IR” cases to the experts where they also have the backing by subspecialists and a cohesive/well run clinical team with follow-up care in the wards. [/b]
          In terms of costs — IR in hospitals does not make money 99% of the time. It is a service that goes as one of the costs of doing business. 

          Couple of problems that we see in our far-flung supraregional practice with multiple hospitals, some quite small:

          1) The referrer base starts howling if you want to transfer a patient from St. Elsewhere to the Ivory Tower just do do some IR procedure that’s not in the “light IR” package. … and the administrators respond to the squeaky wheels.

          2) Fewer and fewer general radiologists have that broad set of described “light IR skills” 

          3) Nobody even wants to be the generalist butt-in-chair rad to even set foot in the small hospital, no less stick a needle in something.

          Natural consequence of regional practice setup. All high RVU stuff sucked out and sent to the hub. One would be crazy to be a road boy or girl and agree to do low rvu procedures. 

          • lisbef3_453

            Member
            May 5, 2023 at 11:30 am

            Those outside hospitals often have less than optimal equipment and techs and can’t stock inventory without it expiring.     Everyone want’s an IR gangsta until it’s time to pay for gangsta shit.