PURPOSE:To estimate the turnover rate and its association with workload and radiologist and practice characteristics given the detrimental aspects of turnover on radiology practices. METHODS:This retrospective study (2013-2022) examined practice turnover rates (leaving one practice to join another) of radiologists by year (radiologist-years). Radiologist and practice characteristics were obtained from CMS (Medicare Data on Provider Practice and Specialty and National Downloadable Files). Radiologists' workload was estimated based on 5% sample of CMS Medicare fee-for-service claims and Inovalon Insights, LLC (Bowie, MD), claims (commercial, Medicaid, and Medicare Advantage). Radiologists' total workload was extrapolated from these claims based on the population represented in these data. Turnover odds by radiologist and practice characteristics and workload were estimated by logistic regression. RESULTS:Between 2013 and 2022, 280,692 radiologist-years (39,439 radiologists) met the selection criteria. Turnover increased from 5.3% to 8.5% (from 2013 to 2022). Adjusted turnover odds were 1.96 (95% confidence interval [CI]: 1.83-2.10) in 2022 versus 2013, were higher for female versus male (odds ratio [OR]: 1.06; 95% CI: 1.02-1.10) and metropolitan versus nonmetropolitan (OR: 1.12; 95% CI: 1.05-1.20), and were lower for academic versus nonacademic (OR: 0.91; 95% CI: 0.86-0.97) radiologists and decreased with years of practice (YOP). The turnover rate decreased as workload increased until reaching a minimum rate-an inflection point-and then increased. This inflection point was lower for academic versus nonacademic radiologists and with more YOP. CONCLUSIONS:Factors associated with higher turnover included excessive workload, nonacademic practices, females, lower YOP, and metropolitan setting. Practices should consider these factors as they design retention efforts.
PURPOSE:The aim of this study was to compare imaging use on pediatric outpatients at children's hospitals (CHs) versus non-children's hospitals (NCHs) to identify differences across modalities that differ in ionizing radiation exposure. METHODS:CMS Medicaid Research Identifiable Files were used to identify all year 2019 pediatric (ages 0-17 years) outpatient claims from hospital outpatient facilities (HOFs) and emergency departments (EDs). CMS data from 2018 were used to calculate the pediatric comorbidity index (PCI) for risk adjustment. Primary outcomes were CT, MR, ultrasound, or radiography (XR) use at each visit, comparing frequencies between CHs and NCHs. Additional covariates included age group (0, 1-2, 3-5, 6-11, and 12-17 years), PCI (0, 1 or 2, 3-6, 7), and place of service (HOF vs ED). RESULTS:A total of 5,474,082 claims meeting the selection criteria were identified. More than half of visits (53%) were to CHs, and 15% were to EDs. CH encounters were more likely (vs NCH encounters) to be among patients aged 0 to 5 years versus >5 years (41.2% vs 38.7%, P < .01), those with PCI > 2 (32.3% vs 22.9%, P < .01), and those seen at HOFs (87.8% vs 81.9%, P < .01). The most commonly used modalities were XR (9.5%) and ultrasound (2.1%). Use of XR (11.8% vs 7.5%, P < .01) and CT (1.0% vs 0.5%, P < .01) was more frequent at NCHS. Use of ultrasound (2.5% vs 1.7%, P < .01) and MR (0.9% vs 0.5%, P < .01) was more frequent at CHs. CONCLUSIONS:This study reveals that imaging modalities that expose children to ionizing radiation are used more frequently at NCHs than at CHs. The clinical implications of these variations warrant further investigation.
Purpose The provision of evaluation and management (E&M) services is crucial to the value of interventional radiology (IR) as a clinically integrated specialty. We aimed to assess E&M’s association, as well as extent to which the radiologist and practice are focused on IR versus diagnostic radiology (IR share), with procedural complexity. Methods Radiologists providing care to Medicare fee-for-service beneficiaries (2008-2023) were mapped to practices and the percentage of care they provided that was IR-related was computed using a 5% sample of these beneficiaries’ claims. Practices with radiologists providing IR-related services were included, as were E&M services provided by nonphysician practitioners (NPPs) in radiology-only practices. Associations between procedural complexity (work relative value units [wRVUs]) and E&M services, practice IR share, and radiologist IR share were assessed using multivariable regression analyses. Results Overall, 29,844 practice-years met selection criteria. Higher practice IR share was associated with higher procedural complexity. The proportional odds that a procedure had ≥5 wRVUs was higher for practices billing >90% to 100% IR work compared with practices with >0% to 10% IR work (odds ratio, 1.62; 95% confidence interval, 1.34-1.96) as were the proportional odds for radiologists with a >90% to 100% IR share compared with a >0% to 10% IR share (odds ratio, 74.74; 95% confidence interval, 65.81-84.89). A 1-wRVU increase in either radiologist or NPP E&M wRVUs per procedure was associated with 0.14 (P = .045 or P = .038, respectively) more wRVUs per procedure. Conclusions The degree of individual radiologist IR specialization, more than practice specialization, most strongly predicts the complexity of care delivered. NPP-provided E&M services were strongly associated with higher procedural complexity.
