Interventional Oncology:
Developing the model in
private practice
David Liu, MD
Interventional Oncology
Angio/Interventional Section
Inland Imaging, LLC
Spokane, Washington
dliu@inland-imaging.com
Interventional Radiology:
Endless Potential To Cure….
Well…maybe not endless….
Is IO a Feasible Direction for IR
In The Private Practice Realm?
Strength
 We
understand and do the imaging
 Expertise in multimodality therapy
 Technical abilities
Weakness
 Lack
of active participation in management
 Under utilization of oncology based procedures
 Our literature is evolving, however will not compare to
pharmaceutical driven studies
Opportunity
 Chance
to develop skills and understanding of disease
process
 No competing specialists; no one with the skill sets that
we have
 Complementary to current paradigms
Threat
 Bottom
feeding; diluting response
 Perception that we are a disruptive technology
 Federal regulatory issues
 Perceived turf issues
Depth of Practice
Proceduralist
Show Up
Educator
Tumor
Board
Clinician
Clinic
Research
Active
Passive
Active
Overview
Creating the Service Line
Establishing the Clinic
The Clinician
Metrics of Success
Creating the Service Line
Technical & Administrative
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Infrastructure for one stop shop
Ensure time off for tumor board
Pitfalls & Pearls
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Not thinking the logistics through
Inconsistency in service
Tumor board attendance is key
Biopsies and central access may be starting points
Passive education and collaboration
Practice Patterns: Tumor Board
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Opportunity to provide expertise in
imaging, diagnosis, staging, and
localregional therapy
Promote all of radiology
Dovetails well with referrals to clinic
Establish reputation in community
Without presence, there will be no referral
Establish the Clinic
Technical & Administrative
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Physical space (clinic, filing)
Dedicated time to see patients
Telephone number
E&M coding process/Assistance (one person)
Pitfalls & Pearls
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Send intake and h&p forms prior to encounter
Discuss and review prior to consultation
Follow up clinic and letter
Work with an NP or a PA
Consistency in your rationale
Match your clinic day with a collaborating
specialty
Collaborative efforts
Work with referring physician, but do
not bog them down with the details
Make it less work for your colleagues to
refer a patient to you
Streamline the review process through
participation in tumor boards
The Clinician
Technical & Administrative
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Be prepared to deal with patients
Ensure outpatient procedures are scheduled
Dedicate clinical time: dictations, filing and access
Pitfalls & Pearls
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Call coverage
Try to avoid coersion from patients and clinicians
If there is not enough information to make a clinical judgment;
investigate further (previous studies, labs, imaging, biopsy)
Round on your patients
Call the primary referring physician
Do not be afraid to refer to another specialist
Patterns: Referral Reciprocity
Multidisciplinary/Multimodality model establish
referral patterns
Self referral patients may require surgical or
medical consultation, but start with an E&M
Team approach can help with preauthorization
Pitfalls:
Getting In Over Your Head
Discuss prior to treatment;
you do not want to be
meeting the primary
oncologist for the first time
with a complication
Avoid becoming the primary
oncologist, maintain your
highly specialized role
Use your facilities: hospitalists,
pharmacy, discharge planners
Metrics of Success
Technical & Administrative
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Productivity of service line may have long lag time
Establish measures with hospital administration
Ensure the halo effect is incorporated into financials
Invest the time to share your vision with your DI
colleagues
Pitfalls & Pearls
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Watch for automatic DRG conversion
Be cautioned about marketing…..
Establish metrics prior to implementation
Passive promotion
Participation in studies promote your service
Ortho, CV & oncology are part of hospital plans
How I Would/Am Do(ing) It:
Start with understanding the literature
Attendance at tumor board: GI & Lung
Suggest procedures as indications arise
Discussion with administration
Begin clinic and promote at tumor board
Develop collaborations with disciplines
Provide a method for cross referrals
Work towards a multidisciplinary clinic
Final Thoughts
Offer a service, not a procedure
Imperative to play a role in clinical cancer care
Educate clinicians while providing black box service
Ensure that your group is on board and supportive
Critical path to success over the next 5 years
1a. Develop mechanism to sustain interdisciplinary
collaboration….
SIR Interdiscp Consensus Panel 2004
‘…similar and coequal to radiation oncology, surgical oncology and
medical oncology…’
SIR IO Taskforce JVIR 2005
Be adjunctive, not disruptive
Interventional Oncology:
Developing the model in
private practice
David Liu, MD
Interventional Oncology
Angio/Interventional Section
Inland Imaging, LLC
Spokane, Washington
dliu@inland-imaging.com