BackTable Vascular & Interventional

Ep. 329 OBLs, Past, Present, and Future with Dr. Bill Julien


Listen Later

In this episode, host Dr. Aparna Baheti interviews Dr. Bill Julien about the evolution of the outpatient based lab (OBL), its role in expanding patient access to IR care, and its relationship with other IR practice models around the country.


---


CHECK OUT OUR SPONSORS


Boston Scientific Ranger DCB

https://www.bostonscientific.com/en-US/medical-specialties/vascular-surgery/drug-eluting-therapies/ranger.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-de_portfolio-hci&utm_content=n-backtable-n-backtable_site_ranger_1_2023&cid=n10012340


Philips SymphonySuite

https://www.philips.com/symphonysuite


---


SHOW NOTES


Dr. Julien is one of the initial OBL founders in the United States. In 2001, he started his current practice, South Florida Vascular Associates in an effort to practice independent IR. At this time, he struggled to get hospital privileges due to exclusive diagnostic radiology contracts, so he placed a C-arm in his office out of necessity. Eventually, he built a formal angio suite. As a result, patients enjoyed the efficiency and comfort of office based procedures, and he enjoyed physician autonomy and freedom from hospital politics. Dr. Julien notes that overtime, CMS has recognized the value of an office-based intervention and saw that IRs could practice high-quality care at a lower price point with higher patient satisfaction, leading to improved Medicare reimbursements.


Since the conception of his OBL, Dr. Julien has seen practice structures change, especially with the influence of venture capital firms and the pressure to generate RVUs. Additionally, though some voices have pushed for more IR involvement in the clinical sphere, there has not been much progress made in advocating for IR hospital privileges. This is a significant barrier to independent IR practices, since some states require that an IR has hospital privileges before opening an OBL. Dr. Julien says that this dilemma is unique to IR, since other specialties, such as vascular surgery and cardiology, are not affected by exclusive contracts to the same extent. He believes that IR societies and leading voices should actively challenge the legal basis of these contracts and support interventionalists who want to stay independent. We highlight recent SIR and ACR position statements on this topic.


Finally, Dr. Julien offers advice to IRs who are seeking to enter the OBL setting. He encourages them to perform and learn from as many procedures as possible, find ways to develop and maintain clinical skills, identify mentors, and ensure that their restrictive covenants are not too stringent.


---


RESOURCES


South Florida Vascular Associates:

https://www.southfloridavascular.com/


Outpatient Endovascular and Interventional Society (OEIS):

https://oeisweb.com/


SIR Position Statement on Exclusive Contracts:

https://www.sirweb.org/globalassets/aasociety-of-interventional-radiology-home-page/practice-resources/standards_pdfs/exclusive_contracts_policy_final_approved_9-21-15.pdf


ACR Position Statement on Exclusive Contracts:

https://www.acr.org/-/media/ACR/Files/About-ACR/2022-2023-Digest-of-Council-Actions.pdf


Line Monkey MD- “The IR Startup:”

https://linemonkeymd.com/the-ir-startup/


Line Monkey MD- “Pseudoexclusive Radiology Contracts:”

https://linemonkeymd.com/pseudoexclusive-radiology-contracts-our-downfall/#comment-2087

...more
View all episodesView all episodes
Download on the App Store

BackTable Vascular & InterventionalBy BackTable

  • 4.8
  • 4.8
  • 4.8
  • 4.8
  • 4.8

4.8

133 ratings


More shows like BackTable Vascular & Interventional

View all
Freakonomics Radio by Freakonomics Radio + Stitcher

Freakonomics Radio

32,085 Listeners

Behind The Knife: The Surgery Podcast by Behind The Knife: The Surgery Podcast

Behind The Knife: The Surgery Podcast

1,304 Listeners

Pivot by New York Magazine

Pivot

9,039 Listeners

How I Built This with Guy Raz by Guy Raz | Wondery

How I Built This with Guy Raz

30,265 Listeners

White Coat Investor Podcast by Dr. Jim Dahle of the White Coat Investor

White Coat Investor Podcast

2,419 Listeners

The Daily by The New York Times

The Daily

111,044 Listeners

The Indicator from Planet Money by NPR

The Indicator from Planet Money

9,520 Listeners

The Daily Show: Ears Edition by iHeartPodcasts and Paramount Podcasts

The Daily Show: Ears Edition

14,185 Listeners

Money Meets Medicine by Doctor Podcast Network, Jimmy Turner MD

Money Meets Medicine

217 Listeners

The Passive Income MD Podcast by Peter Kim, MD

The Passive Income MD Podcast

280 Listeners

The Kinked Wire by Society of Interventional Radiology

The Kinked Wire

6 Listeners

The Prof G Pod with Scott Galloway by Vox Media Podcast Network

The Prof G Pod with Scott Galloway

5,271 Listeners

BackTable MSK by BackTable

BackTable MSK

2 Listeners

Prof G Markets by Vox Media Podcast Network

Prof G Markets

970 Listeners

BackTable Tumor Board by BackTable Inc.

BackTable Tumor Board

0 Listeners