Sources of Revenue Loss and Recovery in Radiology Practices During the Coronavirus Disease 2019 (COVID-19) Pandemic

Abstract

Rationale and Objectives: This study seeks to quantify the financial impact of COVID-19 on radiology departments, and to describe the structure of both volume and revenue recovery. Materials and Methods:Radiology studies from a large academic health system were retrospectively studied from the first 33 weeks of 2020. Volume and work relative value unit (wRVU) data were aggregated on a weekly basis for three periods: Presurge (weeks 1À9), surge (10À19), and recovery (20À33), and analyzed compared to the pre-COVID baseline stratified by modality, specialty, patient service location, and facility type. Mean and median wRVU per study were used as a surrogate for case complexity.Results: During the pandemic surge, case volumes fell 57%, while wRVUs fell by 69% relative to the pre-COVID-19 baseline. Mean wRVU per study was 1.13 in the presurge period, 1.03 during the surge, and 1.19 in the recovery. Categories with the greatest mean complexity declines were radiography (À14.7%), cardiothoracic imaging (À16.2%), and community hospitals overall (À15.9%). Breast imaging (+6.5%), interventional (+5.5%), and outpatient (+12.1%) complexity increased. During the recovery, significant increases in complexity were seen in cardiothoracic (0.46 to 0.49), abdominal (1.80 to 1.91), and neuroradiology (2.46 to 2.56) at stand-alone outpatient centers with similar changes at community hospitals. At academic hospitals, only breast imaging complexity remained elevated (1.32 from 1.17) during the recovery. Conclusion:Reliance on volume alone underestimates the financial impact of the COVID-19 pandemic as there was a disproportionate loss in high-RVU studies. However, increased complexity of outpatient cases has stabilized overall losses during the recovery.

Imaging in the COVID-19 era: Lessons learned during a pandemic

“…Some of the strategies that were enforced include efficient triaging of patients, designation of imaging rooms specifically for suspected cases, meticulous disinfection, enforcement of personal protective equipment (PPE) and shortening of scanning protocols whenever possible. Elective imaging studies were postponed during the first surge of the pandemic, which caused a significant drop in case volumes and a delay in cancer detection[ 15 , 16 ].…”

A Global Review of the Impacts of the Coronavirus (COVID-19) Pandemic on Radiology Practice, Finances, and Operations

“…In this study, the surge period was defined as the period between 2 March 2020 and 10 May 2020. The median RVU per study decreased from 0.76 in the pre-surge period to 0.31 during the surge period [21].…”

“…The decreases in total imaging volume are inherently linked to decreases in total revenue generation in both private practice and hospital-based radiology practices. Moreover, while imaging volume decreased, wRVUs may have decreased to a greater extent than volume, indicating a substantial decrease in the total payment to radiology practices [21]. RVUs are used as metrics to measure the complexity and amount of work required to perform a procedure.…”

“…A study performed within the University of Washington radiology department found that, between January 2020 and May 2020, there was a decline in monthly imaging revenue, with the largest decline in the month of April, where imaging revenue was $86,354,792 compared with $121,166,824.21 in March (Figure 3) [20]. A retrospective study by a large New York health system noted that imaging volume fell by 57% during the surge period and average work RVUs fell by 69% compared with pre-COVID-19 volumes and work RVUs [21]. In this study, the surge period was defined as the period between 2 March 2020 and 10 May 2020.…”