Role of Radiologists in Central Venous Procedures Has Greatly Expanded

June 18, 2013—The Harvey L. Neiman Health Policy Institute (HPI) announced that an institute-sponsored study confirms a major shift in practice at hospitals in the United States regarding central venous procedures. The study found that treatments that were traditionally the domain of surgeons and anesthesiologists are now being performed, in significantly larger numbers, by radiologists.

The study's investigators stated that this change has “profound health system implications.” The HPI paper, “Central Venous Access: Evolving Roles of Radiology and other Specialties Nationally Over Two Decades,” was published by Richard Duszak, Jr, MD, et al online ahead of print in the Journal of the American College of Radiology. Dr. Duszak is Chief Executive Officer and Senior Research Fellow of the Harvey L. Neiman HPI.

“This research should prompt health system leaders and administrators to re-evaluate the role of radiology departments in hospitals,” commented Dr. Duszak in the HPI press release. “We're seeing more radiology practices being displaced from long-standing hospital relationships because administrators think they can outsource all of their radiology needs. National data tells us, though, that radiologists are being relied upon with increasing frequency in the hospital setting to perform central venous procedures.”

As summarized by the HPI, the investigators examined Medicare claims data from 1992 to 2011 for procedures involving central venous catheters and long-term central venous medical devices. The investigators noted that the volume of central venous procedures among Medicare beneficiaries has grown significantly over the past two decades, with the number of long-term central venous device insertions increasing by 313% over that period.

The study showed that radiologists, who once had been responsible for less than 1% of all long-term central venous devices, are now placing more than 48% of tunneled catheters and 27% of all medication ports. In all hospital settings combined, radiology departments are placing three of every four peripherally inserted central catheters.

“This study verifies a significant transition in the way central venous procedures are being handled in United States hospitals,” stated study investigator Danny R. Hughes, MD, in the HPI press release. “Surgeons are stepping away from these functions and radiologists are filling the need. This tells us there is a direct tie between health policy and hospital administration decisions concerning radiology and patient access to these critical health care services.”

As noted on its website, the Harvey L. Neiman HPI was established by the American College of Radiology in 2012 to study the value and role of radiology in evolving health care delivery and payment systems, including quality-based approaches to care and the impact of medical imaging on overall health care costs. The institute's research is intended to provide a foundation for evidence-based imaging policy to improve patient care and bolster efficient, effective use of health care resources.