Are there any pure NeuroIR "groups" out there? Also, why is NeuroIR a loss leader?

[someqsaboutstuff]

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(Not sure what the right specific forum for this, but it seems there are more discussions on the business of NIR on the rads forum vs neuro on SDN.)

I have been intrigued for a while about NeuroIR, and have been quite aware of the terrible lifestyle. I have been reading about other specialties with intense call and how if one is in a group, there are a lot of options for splitting up call. I was also reading that NIR is a loss leader for some groups.

I am wondering if:

1. Can groups of NIRs (can be NSGY, IR or Neuro) take contracts with hospitals/hospital networks rather than multiple docs with separate contracts with a hospital/network?
2. If so, are more "creative" schedules possible? I know DR has jobs like 7nights/14off. Trauma surgeons can do shift work where they do not need to follow the patients they operate on when their shift ends (i think?). Could groups of NIR-only physicians develop similarly unique schedules rather than standard rotating q2-4 call?
3. Why is NIR a loss leader? Is this specifically for DR groups that try to do NIR procedures at a practice rather than at a hospital?
4. If NIR procedures don't reimburse well, how does a hospital make money off of them? Is it purely because they get money from being classified a "comprehensive stroke center"?

Finally, is it possible to find data on the compensation for scheduled procedures, and the regional compensation ranges for 24h call shifts to estimate salaries with different call/scheduled times starting?

 

[guytakingboards]

1. Can groups of NIRs (can be NSGY, IR or Neuro) take contracts with hospitals/hospital networks rather than multiple docs with separate contracts with a hospital/network?

Yes, this is common.

1. If so, are more "creative" schedules possible? I know DR has jobs like 7nights/14off. Trauma surgeons can do shift work where they do not need to follow the patients they operate on when their shift ends (i think?). Could groups of NIR-only physicians develop similarly unique schedules rather than standard rotating q2-4 call?
2. Why is NIR a loss leader? Is this specifically for DR groups that try to do NIR procedures at a practice rather than at a hospital?

NIR in general is a loss leader for DR groups because it requires a lot of call. Call coverage typically often paid on top of group partner salary, costing the rad group double for the NIR plus their call coverage. Additionally while the individual reimbursement for a mechanical thrombectomy is reasonable, the volume is not high. There's no instance where an NIR rad is doing 5-6 declots a night and crushing the RVU's. So NIR's typically don't generate the RVUs anywhere near justifying what they're usually paid. **A popular trend now is for groups to demand call-stipends from the hospitals, similar to surgery. This somewhat lessons the financial hit of having NIRs**.

"Creative" scheduling is not the word I'd use for NIRs but I've seen a few different models within DR groups. Some DR groups have allowed the NIR's to develop clinics and build up an outpatient referral base for things like aneurysm/AVM work, pain, or spine work. Others have their NIR's rotate through diagnostic neuro slots to ameliorate the otherwise low RVU production.

Groups are free to get as creative as they want with NIR scheduling but the fact is anything that has them taking less call over-all is IMO a poor use of a scarce resource. You'd still be paying them highly, but just to do less of the most important/critical task they do (taking stroke call).

1. If NIR procedures don't reimburse well, how does a hospital make money off of them? Is it purely because they get money from being classified a "comprehensive stroke center"?

NIR is the same as any other procedural specialty, whether it be orthopedic surgery or interventional cardiology. The hospital makes money off the procedure itself (cost of the room/equipment used), but the real money is all the downstream ancillary services utilized during the admission. Post-declot the patient is going to the ICU for at least a few days (filling a critical care bed and being cared for by a ICU doc), will utilize a fair amount of follow-up neuroimaging, probably lab studies of some kind, generate consultations for any co-morbities, get downgraded to floor-level care with presumably a transition to (neuro) hospitalist care, get some PT/OT at some point and then after discharge a bunch of follow-up appointments. Basically alot of people/services get to eat off a single LVO admission. A single LVO declot can easily generate high 6 figures to 7 figures in total billings for the hospital system with only a small portion going to the NIR.

Being a CSC only means you are capable of offering the above mentioned services. It is a classification which on its own doesn't get the hospital any more money.

 

[someqsaboutstuff]

Yes, this is common.



NIR in general is a loss leader for DR groups because it requires a lot of call. Call coverage typically often paid on top of group partner salary, costing the rad group double for the NIR plus their call coverage. Additionally while the individual reimbursement for a mechanical thrombectomy is reasonable, the volume is not high. There's no instance where an NIR rad is doing 5-6 declots a night and crushing the RVU's. So NIR's typically don't generate the RVUs anywhere near justifying what they're usually paid. **A popular trend now is for groups to demand call-stipends from the hospitals, similar to surgery. This somewhat lessons the financial hit of having NIRs**.

"Creative" scheduling is not the word I'd use for NIRs but I've seen a few different models within DR groups. Some DR groups have allowed the NIR's to develop clinics and build up an outpatient referral base for things like aneurysm/AVM work, pain, or spine work. Others have their NIR's rotate through diagnostic neuro slots to ameliorate the otherwise low RVU production.

Groups are free to get as creative as they want with NIR scheduling but the fact is anything that has them taking less call over-all is IMO a poor use of a scarce resource. You'd still be paying them highly, but just to do less of the most important/critical task they do (taking stroke call).



NIR is the same as any other procedural specialty, whether it be orthopedic surgery or interventional cardiology. The hospital makes money off the procedure itself (cost of the room/equipment used), but the real money is all the downstream ancillary services utilized during the admission. Post-declot the patient is going to the ICU for at least a few days (filling a critical care bed and being cared for by a ICU doc), will utilize a fair amount of follow-up neuroimaging, probably lab studies of some kind, generate consultations for any co-morbities, get downgraded to floor-level care with presumably a transition to (neuro) hospitalist care, get some PT/OT at some point and then after discharge a bunch of follow-up appointments. Basically alot of people/services get to eat off a single LVO admission. A single LVO declot can easily generate high 6 figures to 7 figures in total billings for the hospital system with only a small portion going to the NIR.

Being a CSC only means you are capable of offering the above mentioned services. It is a classification which on its own doesn't get the hospital any more money.

Thank you for your detailed insight! Do you think a growing trend is groups of NIRs forming group contracts with hospitals rather than being part of a Rads practice?

Also to clarify my understanding: NIR generates $ for the hospital for downstream services but their actual procedure volume is considerably less compared to other procedural specialties like eg ortho?

Another question: are NIRs required to follow the patients they do thrombectomies on while on call, or is it like shiftwork where they don’t have to followup on the patient?

 

[guytakingboards]

Thank you for your detailed insight! Do you think a growing trend is groups of NIRs forming group contracts with hospitals rather than being part of a Rads practice?

No. There is an overall relatively small number of NIR's around and as mentioned they're high-cost, low reimbursing so it doesn't make a ton of sense to bunch them together. Their services need to be subsidized by someone else, whether that be by a DR group, NSGY group or the hospital system itself.

Also to clarify my understanding: NIR generates $ for the hospital for downstream services but their actual procedure volume is considerably less compared to other procedural specialties like eg ortho?

Correct. Population incidences of LVO/MVO is extremely low. Per this journal of Neurointerventional Surgery article from 2022, the incidence of LVO/MVO per 100,000 per year is 44. So imagine a city of 1 million people. If there was 1 NIR available for the entire city catchment and on-call every day of the year he would do 440 declot procedures. If you condensed that down to 200 working days, that's still only 2.2 procedures per day. Ortho is doing way more than 2.2 operations per day.

TBF, NIR's do do other stuff like AVM/aneurysm work, spine, and pain stuff in addition to the declots.

Another question: are NIRs required to follow the patients they do thrombectomies on while on call, or is it like shiftwork where they don’t have to followup on the patient?

For thrombectomies, from what I've seen they usually drop a follow-up note or two and then leave the care in the hands of the neuro/NCC doc. For aneurysm/AVM work (particularly ruptured aneurysm work), they're more closely following the patient in case they need to take the patient back for another angiogram. For aneurysm work, the clinical follow-up is something the NIR's can choose to do if they have a clinic... or leave it to the neurologists.