A model for merging vascular surgery and interventional radiology: Clinical and economical implications

Background: The traditional separation of vascular surgery and intervention al radiology into distinct units is associated with inefficiencies in patie nt care, practice management, and training. Traditional departmental politi cs, discrepant clinical backgrounds and philosophies, fear of decreasing re muneration, and basic differences in education, training, and practice have all rendered mergers difficult. Methods: We have implemented a model that incorporates all the clinical, fi scal, and educational activities of the 2 former entities into a single uni t. A 5-physician vascular surgery group, its noninvasive laboratory, and a 3-physician interventional radiology group were unified. The revenue was de posited into a single account from which all the expenses were paid. The ne t income of the joint unit was apportioned on a predetermined pro rata basi s, with scaled percentages for each practitioner. In an effort to separate clinical decision making from economic pressures, the individual physician remuneration was not on the basis of productivity. Clinical volume, gross r evenue, and remuneration were compared with the 12-month period that immedi ately preceded the merger and contrasted to the previous a-year historical trend (HT). Results: The number of vascular surgical procedures fell after the merger ( -9.3%; HT, +4.7%). By contrast, the number of interventional radiology proc edures rose (+56.1%; HT, +15.2%), as did the number of noninvasive testing (+9.2%; HT, +3.5%). In concordance with the number of procedures, the gross revenue of vascular surgery fell (-23.7%; HT, +1.1%) and that of intervent ional radiology rose (+53.5%; HT, +46.0%). The increased efficiencies allow ed the total expenses of the 2 units to fall (-13.2%; HT, +7.5%), and, desp ite the reduced revenue, the vascular surgeon remuneration was preserved (0.7%; HT, -3.9%) and the radiology remuneration rose (+22.3%; HT, +8.3%). T he merger allowed the vascular surgery fellows to actively participate in 2 6 interventional cases per month and the interventional radiology fellows t o actively participate in 8 open surgical cases per month. Conclusion: The merger of vascular surgery and interventional radiology res ulted in a decrease in the surgical procedures and revenue, with a correspo nding increase in the interventional radiology procedures and revenue. Desp ite these effects, the physician remuneration increased as a result of the improved efficiencies in practice management and the reduction in expenses. The merger of the 2 units excludes the economic pressures from clinical de cision making and appears to be warranted on the basis of the fiscal and ed ucational benefits that are achieved.