Research on Central Venous Procedures Shows More Involvement by Radiologists

Evidence that radiologists inserting more central line catheters, medication ports and pumps have significant health system ramifications


October 29, 2013

October 29, 2013 — The findings of a Harvey L. Neiman Health Policy Institute study published online in the Journal of the American College of Radiology (JACR) confirm a major shift in practice at American hospitals regarding central venous procedures. What has traditionally been the domain of surgeons and anesthesiologists is being performed, in significantly larger numbers, by interventional radiologists, a change that the paper’s authors say has “profound health system implications.”

The Harvey L. Neiman Health Policy Institute paper, “Central Venous Access:  Evolving Roles of Radiology and other Specialties Nationally Over Two Decades,” was released online by the JACR earlier this year. The authors examined Medicare claims data from 1992 to 2011 for procedures involving central venous catheters and long-term central venous medical devices.

“This research should prompt health system leaders and administrators to re-evaluate the role of radiology departments in hospitals,” said Richard Duszak, M.D., FACR, CEO of the Neiman Institute and the paper’s lead author. “We’re seeing more radiology practices being displaced from long-standing hospital relationships because administrators think they can outsource all of their radiology needs. National data tells us, though, that radiologists are being relied upon with increasing frequency in the hospital setting to perform central venous procedures.”

The paper notes that the volume of central venous procedures among Medicare beneficiaries has grown significantly over the past two decades, with the number of long-term central venous device insertions increasing by 313 percent over that period. The researchers found that radiologists were once responsible for less than one percent of all long-term central venous devices, but now place over 48 percent of tunneled catheters and 27 percent of all medication ports. In all hospital settings combined, radiology departments are placing three of every four peripherally inserted central catheters.

“This study verifies a significant transition in the way central venous procedures are being handled in U.S. hospitals,” said Danny R. Hughes, Ph.D., one of the study’s authors. “Surgeons are stepping away from these functions and radiologists are filling the need. This tells us there is a direct tie between health policy and hospital administration decisions concerning radiology and patient access to these critical healthcare services.”

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