Abstract No. 99 Financial reimbursement in interventional radiology procedures: multicenter analysis within the Americas

Abstract

To compare financial reimbursement costs related to interventional radiology procedures (IRP) across USA, Canada (Ontario) and Brazil Medicare Billing (based on RVU and CPT codes) obtained from a single institution was considered as the primary database for US billing. USA Procedure Reimbursement Fees (PRF) included billings in NON FAC PAR, NON FAC NON PAR, NON FAC LC, FAC PAR, FAC NON PAR and FAC LC categories. However, NON FAC PAR fees were utilized as a US Standard baseline for comparison with Ontario and Brazil. Brazilian private PRF were obtained from a single institution. Canadian billings were obtained from a single institution in Ontario (OHIP Database). Equivalency factor for standardization of PRF included the pre-COVID cost of living adjusted income (using proportionate household disposable income as a basis) and pre-COVID foreign exchange rate for each country (February 2020), relative to USA. All currency values were presented in US dollar equivalent. 32 of 45 procedures met inclusion criteria with PRF present for each country. Procedures with fees not available in 1 or more countries were excluded. Brazil-USA: 19 (59%) procedures demonstrated an average of 66% lower fees in Brazil as compared to USA. Some of these procedures include varicocele embolization, portal vein embolization, uterine fibroid embolization, Gastrojejunostomy tube placement and IVC filter placement. Only 12 (37%) procedures demonstrated an average of 219% higher fees in Brazil as compared to USA. Canada-USA: 22 (69%) procedures were underpaid in Ontario (-95% to -19%). Some of these procedures include biliary stent insertion, CT-guided visceral biopsy, port insertion, cholecystostomy tube, carotid stenting, hepatic radiofrequency ablation, thoracocentesis, mesenteric stenting and suprapubic catheter insertion. 1 (3%) procedure was similar in PRF (variance within ±5%). Variable PRF across nations has resulted in relatively low reimbursement fees in Brazil and Canada. Based on cost-of-living adjusted income and foreign exchange rate, a PRF reform is needed, in order to standardize IRP fees in Brazil, Canada and USA.