Rural Care Settings Need More Radiology Expertise

Rural Care Settings Need More Radiology Expertise Recently, a study by a joint task force of the American College of Radiology (ACR) and the Society of Interventional Radiology (SIR) pointed out the need for all diagnostic radiologists to have certain competencies in “Level 1” interventional procedures. Radiology Business reports that the aim of the task force was making recommendations for “broadening access to image-guided procedures for patient populations living in rural care settings or served by small IR practices.” According to the study abstract, “Radiology practices characterized as small and rural are challenged to recruit and retain interventional radiologists”, resulting in a failure to meet the needs of patients and others in these communities. Thus, having diagnostic radiologists with Level 1 competencies in small practice or rural health settings increases their ability to provide a wider range of needed services.

Level 1 interventional procedures include PICC, para/thoracentesis, joint aspiration via arthrography, thyroid and breast biopsies, and lumbar puncture for cerebrospinal fluid drainage. These are procedures that can also be performed by non-physician providers subject to their state licensure, as we discussed in our recent articles How Can the Use Of Physician Extenders Benefit a Radiology Practice? and Expanded Authorization for Non-Physician Providers.

Level 2 procedures require greater complexity and the use of equipment that might not be present in small or rural hospitals, and they are not considered by the research team to be expected as part of diagnostic radiology training. Level 2 includes, for example, tunneled and non-tunneled central line placement, vascular port or pump placement, IVC filter placement, gastrostomy placement, and percutaneous nephrostomy placement, along with the replacement and removal of these.

The term ‘rural’ is defined differently by various federal agencies. The Centers for Medicare and Medicaid Services (CMS) has established several types of facilities under its Health Equity Programs, designed to provide payment for outpatient services to rural and other underserved areas. These include Rural Health Clinics (RHC), Critical Access Hospitals (CAH), and Federally Qualified Health Care (FQHC) facilities. An RHC must be in an area defined by the US Census Bureau as ‘non-urbanized’ whereas a CAH must be in a rural area that is more than a 35-mile drive from another hospital or more than a 15-mile drive from another hospital in an area with mountainous terrain or only secondary roads. The definition of a FQHC does not have a rural location component, but rather it is a facility that is a safety net outpatient clinic approved for federal funding.

The payment system varies for each of these types of facilities. RHC’s, for example, receive a bundled payment, or All-Inclusive Rate (AIR), for primary care and preventive health services while CAH’s receive cost-based reimbursement. Physician services are either paid separately under the Medicare Physician Fee Schedule (MPFS) or as part of the hospital’s facility fee, depending on the hospital’s election under the program. Physicians might also qualify to receive an additional incentive payment if the facility is located in certain underserved areas.

The most comprehensive source of information about rural health is online at the Rural Health Information (RHI) Hub, sponsored by the Health Resources and Services Administration (HRSA). Additionally the Centers for Medicare and Medicaid Services (CMS) provides a wealth of information for physicians and other providers. Subscribe to this blog for the latest information.

Sandy Coffta is the Vice President of Client Services at Healthcare Administrative Partners.