1. Interventional Oncology: Developing the model in private practice
David Liu, MD
Interventional Oncology
Angio/Interventional Section
Inland Imaging, LLC
Spokane, Washington

2. Interventional Radiology: Endless Potential To Cure….
Well…maybe not endless….

3. 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

4. Depth of Practice Passive Active Show Up Tumor Board Clinic Active
Proceduralist
Educator
Clinician
Research
Show Up
Tumor Board
Clinic
Active
Passive Active

5. Overview
Creating the Service Line
Establishing the Clinic
The Clinician
Metrics of Success

6. Creating the Service Line
Technical & Administrative
Infrastructure for one stop shop
Ensure time off for tumor board
Pitfalls & Pearls
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

7. Practice Patterns: Tumor Board
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

8. Establish the Clinic Technical & Administrative Pitfalls & Pearls
Physical space (clinic, filing)
Dedicated time to see patients
Telephone number
E&M coding process/Assistance (one person)
Pitfalls & Pearls
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

9. 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

10. The Clinician Technical & Administrative Pitfalls & Pearls
Be prepared to deal with patients
Ensure outpatient procedures are scheduled
Dedicate clinical time: dictations, filing and access
Pitfalls & Pearls
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

11. 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

12. 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

13. Metrics of Success Technical & Administrative Pitfalls & Pearls
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
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

14. 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

15. Take responsibility for what you do
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
Take responsibility for what you do

16. Interventional Oncology: Developing the model in private practice
David Liu, MD
Interventional Oncology
Angio/Interventional Section
Inland Imaging, LLC
Spokane, Washington