Possibilities to Realities

By Stephen T. Kee, MD, MMM, FSIR

Chair, SIR Foundation

As you’ve read over the past several months in member communications, the Society of Interventional Radiology (SIR) will be introducing a new and enhanced brand identity in 2015—so that both the society and SIR Foundation may better communicate the value and limitless potential of image-guided therapy. You can read more about this exciting initiative in the below posts from SIR President James B. Spies, MD, MPH, FSIR, and SIR Executive Director Susan E. Sedory Holzer, MA, CAE. 

Our research has shown that that SIR and SIR Foundation must be seen more distinctly as essential, expert resources for IR—not only with our members but with health care decision-makers, influencers and consumers, who are shaping the new health care landscape in which we work and live.

SIR Foundation will continue to advance the clinical needs of IR by specializing in developing investigators trained in conducting basic and clinical trials research and supporting innovative treatments delivered through image-guided techniques. We have initiated a new program structure that proactively fosters research priorities in the areas of clinical research, research policy and research education. These priority areas drive our program, grant-making and fundraising decisions.

As 2014 comes to a close, I wanted to share some specific successes. A memorandum of understanding (MOU) has been executed between SIR and the American College of Radiology (ACR) to begin building an IR registry database under the National Radiology Data Registry (NR DR). ACR has begun building the IR registry database, and you’ll be hearing more about this exciting development throughout next year. The foundation hosted a research consensus panel that proposed 13 new Physician Quality Reporting System (PQRS) measures—6 of which are now on the Centers for Medicare & Medicaid Services (CMS) Measures Under Consideration (MUC) list—a vital step toward systematic data collection. Medical students around the nation are being introduced to IR through our research internships and awards. Our premier grants program continues to grow in prominence, adding several new awards this year. In 2015 and beyond, we will continue to articulate how the foundation is the premier scientific organization dedicated to advancing IR through research.

As always, these achievements are only possible with your support. You enable SIR Foundation’s work of developing, testing and implementing breakthrough medical treatments. You continue to turn possibilities into realities.

This is a very exciting time as SIR and SIR Foundation prepare to better communicate the unique strengths and limitless potential of IR. You will soon hear more about our branding assessment and its impact on the external voice and face of the SIR and SIR Foundation. I look forward to hearing what you think about our branding and SIR Foundation initiatives.

We’re Listening

By James B. Spies, MD, MPH, FSIR

SIR 2014–15 President

You’re not listening to me! How often will we say (or even hear) those words over our lifetime?

My hope is that you won’t need to use those frustrating words when talking about SIR. When it comes to your society, its mission, vision, and educational, advocacy, awareness and research efforts, we listen to our essential audience—you. This type of listening doesn’t require an advanced degree in espionage; it requires SIR to be present for you.

Your opinions matter—whether in addressing your specific needs to advancing a better understanding of IR and its positive impact on patient care. SIR’s cadre of volunteer physicians are developing data registries to meet the quality monitoring needs of you and your patients; adopting program requirements for the IR Residency and transitioning our current programs to that new standard; initiating the PRESERVE trial to study the safety and effectiveness of IVC filters currently in use in this country; and ensuring that policy makers understand the unique benefits of IR while addressing barriers in coding and payment.

In addition, we have conducted an SIR Foundation research consensus panel to provide education and insight on the process of developing performance measures relevant to IR practices; submitted 13 performance measures to CMS for review and possible addition to the 2015 measures under consideration; provided a comment letter to FDA regarding laparoscopic morcellation of fibroids and the risk of missed malignancy, highlighting the need for women with symptomatic fibroids to know about all treatment options and related risks; identified member needs related to our strategic plan and defended coverage of endovascular procedures for intracranial arterial disease with a private insurance carrier. Beyond these efforts, we are completing a new blueprint for education, exploring new methods of providing member services and began a discussion on new innovative models of practice. These are but a few instances of where we listened and acted on your behalf.

As part of our brand update process (detailed by Executive Director Sue Holzer in “Strengthening Our Story”)—we held in-depth interviews with numerous members to understand what you think about and hope for the Society, the Foundation and the specialty. What we learned was insightful, sometimes surprising and critical in defining what we’re known for, what individuals expect from us and how we can develop new ways of reaching out to key audiences.

You believe, and rightfully so, that IR showcases the very best of today’s medicine—bringing together doctor insight, professional expertise and advanced image-guided technology to solve the toughest medical problems with less risk and minimal discomfort for patients. You see the society as inclusive and critical in supporting innovation, furthering the profession and offering essential training. You value creativity, patient interaction and collaboration. While you are delivering integrated care, perception lingers among other medical professionals that we may simply be proceduralists. This is for us to address, as a member put it this way, “We have a bit of an identity crisis.”

We also listened to the many important audiences that influence our specialty. As a result of the assessment, our new brand will enable us to position SIR as the indispensable expert resource for the field and SIR Foundation as the premier scientific body dedicated to advancing IR through research. You’ll hear more about how we are fortifying “who” we are in the coming months.

I look forward to hearing what you think about any of these initiatives.

Strengthening our story

By Susan E. Sedory Holzer, MA, CAE
SIR Executive Director

Next year, SIR will introduce a new and enhanced brand identity to our members and the world. As we prepare for that, I wanted to share with you all of the thinking and work that has brought us to this very exciting point in time.

Increasing awareness of interventional radiology is one of the five goals in SIR’s strategic plan for being the first choice for image-guided therapy. We believe this won’t happen unless SIR and SIR Foundation are more distinctly seen as essential, expert resources for IR—not just in the eyes of our members—but among the health care decision-makers, influencers and consumers who are shaping the new health care landscape in which we work and live.

In winter 2013, the society embarked on a brand assessment with a global public relations firm with offices in Washington D.C., to evaluate perceptions of IR and critically assess the SIR and SIR Foundation brands. Leveraging the 2013 Annual Scientific Meeting, we conducted in-depth interviews with numerous members—volunteers, established practitioners, trainees, medical students, corporate partners—about SIR, SIR Foundation and the way we communicate about our specialty. Follow-up interviews were conducted with more members and with policy-makers, hospital administrators, referring physicians and patients to further hone our understanding of what makes IR, SIR and SIR Foundation unique.

The assessment yielded valuable insights for improving our messaging amid the changing environment.

•  As a society and a specialty, we must be more audience-centric in our communications. Each of the many different audiences important to our specialty should understand our value in terms that matter to them, not just in terms of the treatments we provide.

• There must be a clarion call to focus on collaboration, not competition. Even when the stakes and turf wars are at their highest, SIR can gain from collaborating with other organizations to shape the expansion of IR into new clinical areas and patient teams and solidify ourselves as the embedded expert to these organizations.

• We must show how the very essence of IR is agile and modern. Siloed specialties are old-fashioned and expensive; hospitals, insurers and patients want physicians who are flexible and agile. SIR is uniquely positioned to show how IR delivers on the very things modern medicine asks for: better outcomes, less burden on the patient and innovative use of technology with clear patient benefit.

• We need to portray SIR and SIR Foundation as distinct but complementary organizations working in service of IR.  Our members are excited about the impact of research on the specialty, but few are clear about the difference in missions between the two organizations or what their dues fund. Highlighting the role of SIR Foundation-funded research reinforces the sustained vision of SIR Foundation and its investment potential for members, patients and other key audiences.

Interventional radiology has provided innovative care for patients for more than 40 years, and in that time, SIR has changed our name once and our logo twice. We have never stopped defining the future of medicine and adapting to the ever-evolving health care landscape. Now—perhaps more than ever—we are guided by the inspiration and promise of IR’s limitless potential. The time has come to tell our story confidently and compellingly in everything we do.

I’m interested in hearing your thoughts and comments on strengthening our story.

Strategic Thinking … and Action

By James B. Spies, M.D., MPH, FSIR

SIR 2014–15 President

Advancing a better understanding of both the limitless potential of interventional radiology and its positive impact on patient care will be a main focus during my term as president.

We are very fortunate to have a solid strategic plan guiding our Society and the Foundation toward the ultimate vision of making interventional radiology the first choice in image-guided therapy.  The plan was forged through a highly collaborative process that involved the many voices of IR and considered the many facets of our specialty.

At a tactical level, SIR and the SIR Foundation will continue to organize their efforts around these five key goals: clinical practice, outcomes data, revenue growth, awareness of IR and innovation. As president, my goal is to guide the Society in building on the incredible work that has been done to date across all of these areas. 

Specifically, I am committed to helping SIR make significant progress with these critical initiatives.

• Developing data registries to meet the quality monitoring needs of members and your patients: We have made great strides in the past year and will be testing systems in the coming year.

• Adopting program requirements for the IR/DR pathway and transitioning our current programs to that new standard: SIR fought hard to bring about ABMS approval and enthusiastically supports the changes that are coming in practice and in IR residency training. The program’s implementation will take time, and SIR is committed to ensuring its success. SIR will continue to need your support—and your feedback—as the training program unfolds.

• Starting the PRESERVE trial to study the safety and effectiveness of IVC filters currently in use in this country: Working with the Society for Vascular Surgery, our goal is to ensure the safest practice for patients in our efforts to prevent pulmonary embolus.

• Completing a review of our educational efforts and Annual Scientific Meeting: Our intent is to improve both to better meet your needs in this challenging health care environment.

• Enacting branding initiatives for SIR and SIRF: In another step toward achieving our vision of being the first choice for image-guided treatments we will use coordinated activities to increase awareness among key decision-makers about what IR is, does and achieves; to position SIR as the indispensible expert resource for the specialty; and to show SIR Foundation as the premier scientific body dedicated to advancing IR through research.

This is a very exciting time as we continue to clarify our brand so that we may better articulate the unique strengths and limitless potential of IR. You will hear more about branding this year and its impact on the external voice and face of the SIR and SIR Foundation.

Strategy and goals alone do not bring the Society closer to its envisioned future. That only happens when governing—the work of the Executive Council—becomes a pro-active process.  Another goal of mine is to change our governing operations to focus more on our strategic plan and better monitor the efforts and communications of all divisions of SIR. What does this mean? By effectively transitioning our current model to a new one that leverages focused, proactive planning, greater role clarity and year-round communication, strategy and governing will work even better together—smarter and more efficiently—for you and for IR.

It is an honor to serve as your president. At March’s successful Annual Scientific Meeting in San Diego, we shared ideas with friends and colleagues—all under the theme of “Convergence.” This appropriate theme speaks to IR’s multidimensional nature in daily practice and as a global specialty. It also describes SIR’s collective and confident actions—with you, with IR and with the Society and SIR Foundation. I’ve been involved with SIR for my entire professional life, and I encourage you to volunteer with the Society. Together, we will be able to continue our forward momentum, enhancing our programs to ensure the growth of the specialty, SIR and SIR Foundation.

SIR 2014 Presidential Address

SIR Scott C. Goodwin, M.D., FSIR
SIR President 
March 25, 2014

We are living through some of the most dramatic changes in America's health care system since the advent of Medicare—the Affordable Care Act—potential changes to the SGR formula—more regulation by accrediting bodies with an ever increasing emphasis on documentation and quality.

Navigating Today’s Medical Landscape
The Society of Interventional Radiology continues to work for its members and is navigating a path to success for our specialty during this time of changes in the national health care environment.

In response to nationally mandated expectations of improved quality at lower cost, SIR has pursued multiple pathways to help ensure the future success of interventional radiology. SIR is collaborating with colleagues from other specialties to prevent or limit payment rate reductions. SIR remains an active participant in the national CPT coding process and the accompanying code valuation, which takes place as part of American Medical Association (AMA) Relative Value Scale Update Committee (RUC) activities. We have invested hundreds of volunteer hours and staff resources in ensuring that our coding and valuation strategy is grounded on sound data driven by what is optimal for patient care. We have worked long and hard, and we have been able to preserve excellent value for interventional radiology treatments.

SIR and SIR Foundation have carefully examined various activities in order to ensure that they are consistent with our strategic goals, with an eye on ensuring that the Society’s and the Foundation’s pursuits are fully aligned. The Society established the Payment, Research and Policy Task Force (or PReP) to identify and prioritize data development and research needs to improve patient care in the long term and to help lead to a more efficient reimbursement system. Task force members are working to identify areas where IR is expected to excel—the focus will be on demonstrating exceptional quality, safety, efficacy and value. They are reviewing what services are most valuable to patients and interventional radiologists in order to prioritize where efforts would have the most impact.

SIR and SIR Foundation recognize the critical need for IR evidence-based data to ensure proper support from lawmakers, as they move away from a fee-for-service system toward a system that rewards quality, efficiency and innovation. It is time to demonstrate the safety, efficacy and cost-effectiveness of our treatments.

Transforming Interventional Radiology
We are addressing evolving health care system concerns at the same time as we are celebrating the transformation of the field, as evidenced by interventional radiology becoming a primary specialty in medicine. Longitudinal care has been advocated for and envisioned by leaders in the field for decades, and we are now at the tipping point of a transformation to a fully clinical practice specialty.

The acknowledgement of interventional radiology as a unique clinical specialty has long-lasting implications for the future. We know that this benefits our patients and our practices and strengthens the future of the specialty. Our unique skill set as superb clinicians, expert proceduralists and excellent imagers—a convergence of talents, abilities and interests—has positioned interventional radiologists to be at the forefront of modern medicine. SIR fought hard to bring about American Board of Medical Specialties approval and enthusiastically supports the changes that are coming in practice and in IR residency training. One step has been for SIR to become a sponsoring member of the American Board of Radiology, guaranteeing a prominent voice in developing the professional standards for the IR residency.

Creating an IR Residency Program
The training paradigm for interventional radiology is undergoing an exciting change—one that will ensure that future interventional radiologists provide optimal image-guided care for patients. SIR wants to ensure that trainees are equipped with the tools they need to deliver this care as clinicians, proceduralists and imagers. The creation of the IR residency within the Accreditation Council for Graduate Medical Education will take time and effort, and there will be a gradual transition phase over several years. .

SIR will continue to need your support—and your feedback—as the training program unfolds. The program’s implementation will take time, and the Society is committed to ensuring its success.

Collaborating Strategically
Another effort is SIR’s engagement in strategic collaborations, such as with the American College of Radiology and its Task Force on the Implementation of the Clinical Practices of Interventional Radiology and Interventional Neuroradiology. SIR is working to enhance and promote the growth and sustainability of IR and INR clinical services within the practice of radiology and within the health care system.

The Society’s strategic action plan centers on addressing: clinical education; developing evidence and quality registries; creating financial models to address sustainability and patient access to IR; and increasing awareness of the importance of interventional radiology and interventional neuroradiology to major stakeholders through an educational campaign and by co-publishing articles demonstrating IR and INR value and productivity, as well as clinical scenarios and strategies.

Convergence—or moving toward union—was an apt theme for SIR’s 2014 Annual Scientific Meeting. It attested to interventional radiology’s multidimensional nature in daily practice and as a global specialty. It enunciated SIR’s collective and confident actions, which embrace change. There is an undeniable convergence at work—revolving around you, SIR, the SIR Foundation and the international community of interventional radiology.

Interventional radiology has experienced a rapid global expansion over the past 50 years. SIR continues to work for the global advancement of the profession so that patients around the world will have access to, and benefit from, IR procedures. SIR’s International Task Torce provides guidance to the Society leadership on key international issues, programs and activities. The task force initiated the SIR International Scholarship Program, which is building relationships with future international IR leaders and fostering the development of IR in countries where it does not currently exist. The task force also facilitates U.S. observerships for international IRs, visiting faculty for international meetings and delegations. SIR collaborates with many of the more than 40 IR societies around the world. SIR also supports the exchange of scientific knowledge through our flagship publication, the Journal of Vascular and Interventional Radiology, and an excellent Annual Scientific Meeting.

SIR is fortunate to have many passionate, enthusiastic and energetic volunteers. We also have a very hard-working, capable staff, led by Susan E. Sedory Holzer. They all deserve our thanks for their hard work this past year, which has led to so many wonderful successes.

It has been an honor to serve as your president. Throughout my entire professional life I’ve been involved with SIR, and I encourage you to volunteer with the Society. Together, we see the value of our specialty and its continued potential in raising the quality of medical care. Together, we will navigate interventional radiology’s path to continued success at home and abroad.

Physician Payments Sunshine Act (Open Payments Program)

By Susan E. Sedory Holzer, MA, CAE
SIR Executive Director

Here Comes the Sun. (Sunshine Act, that is.)

By now, you have likely read or heard something about the Physician Payments Sunshine Act. Passed as part of the Patient Protection and Affordable Care Act in 2010, the Sunshine Act is designed to bring transparency to financial relationships that the drug and device industry have with physicians and teaching hospitals.

The burden of this law falls mainly to the manufacturers of drugs, devices, and biologicals that participate in U.S. federal health care programs and to group purchasing organizations (GPOs), who are now required to collect and report on selected financial interactions (like research funding, meals, honoraria, or travel reimbursement) between the company and individual physicians. The Act requires manufacturers and GPOs to report ownership interests held by physicians and their immediate family members. The Centers for Medicare and Medicaid Services (CMS) have developed an Open Payments system for gathering and posting most of this information on a public website. And while there have been numerous delays in implementation, the annual cycle has officially begun, with the first public reports scheduled to be posted by September 30, 2014, and annually after that. Physicians are guaranteed a 45-day window of opportunity to review the reported data and an additional 15 days to dispute inaccuracies.

While neither you, nor SIR, are required to make reports to the government, SIR is committed to helping everyone navigate this law and how it will affect you. SIR has developed this webpage to help you stay informed about the Sunshine Act, which contains links to additional resources from the AMA and from CMS. As physicians, you should prepare yourself by understanding what interactions could appear on the public website. You also need to take advantage of the window that will be offered to you to review reported payments before they are posted publically, and be prepared to dispute any errors.

In some cases, payments made from manufacturers to physicians come indirectly through a professional organization like SIR or the SIR Foundation and will require reporting by the manufacturers. SIR and the SIR Foundation are committed to letting our members and attendees know in advance whenever an SIR or SIR Foundation activity could result in a report, so you have the opportunity to decide for yourself whether to participate. To some extent, though, all SIR educational meetings, involving applicable manufacturers or GPOs are impacted by the Sunshine Act.

SIR has also chosen to accommodate manufacturers exhibiting at the Annual Scientific Meeting by assisting in the data collection process. The bar coded badge system we have used for several years was expanded in 2013 to also include the National Provider Identification (NPI) number for meeting attendees who voluntarily submitted their numbers as part of the registration process. This allows companies who provide payments or other reportable items of value to obtain the data they need for accurate reporting. Our belief is that facilitating the accuracy of data reported is of significant benefit to our members and attendees. SIR will continue this process at SIR 2014 in San Diego.

Realistically, it will very rare for any physician to not have been the recipient of some monetary or in-kind support of $10 or greater from some company. For many, consultation and speaking fees, research grants, meeting support, etc. exceed the threshold by substantial amounts. Thus, the extent to which this kind of transparency will shed meaningful light on appropriate physician-industry relationships, or merely contributes to information overload, remains to be seen.

In the meantime, SIR is committed to updating you on any changes, clarifications and pending deadlines. Please feel free to contact us directly with your questions and concerns.

Navigating by Our North Star

By Scott C. Goodwin, MD, FSIR
SIR President
Winter 2014

We are transitioning from an era of fee for service to a new physician payment model at least in part based on reimbursement directly linked to quality. We will likely see cuts in reimbursement for many key interventional radiology procedures. So what are we to do? What will our guiding star be, our North Star, if you will? Foremostly, we must keep our eyes and actions directed on what we do best: ensuring constant access to and delivery of longitudinal high-quality, image-guided patient care. As part and parcel of this we must remain actively engaged in influencing the outcome of the evolving payment paradigms.

How will 2014 payment cuts impact care delivery and patient access? Reimbursement issues affect both doctors and our patients by impacting what services we offer and the time we spend with patients. These can negatively impinge on patients’ access to quality doctors (thus adding to their stress and diminishing their satisfaction levels).

How can we as a Society best influence reimbursement decisions? In this nationally mandated process of squeezing savings from the health care system, interventional radiology is not alone. We share and collaborate with colleagues from other specialties when payment rates are being reduced (due to code bundling and cumulative reductions). SIR remains an active participant in the national current procedural terminology (CPT) coding process and the accompanying code-valuation, which take place as part of the activities of the Relative Value Scale Update Committee (RUC).

What payments cuts are coming? In 2014, new families of CPT codes for embolization procedures, intravascular stenting and percutaneous drainage have been approved and are now in use. Depending on geographic variations we expect reimbursement for some of these procedures to possibly fall by as much as 30–40 percent.
SIR has invested hundreds of volunteer hours and member resources in ensuring that our coding and valuation strategy is grounded on sound data and on what is the optimal patient care protocol. We have worked long and hard, and we were able to preserve excellent value for IR treatments. In a comment letter to Centers for Medicare & Medicaid Services (CMS) on the 2014 Final Rule for the Medicare Physician Fee Schedule, we have emphasized that the best venue for making relative value unit (RVU) decisions is to use the RUC process, and not to make unilateral further reductions beyond what the RUC recommended without input from specialty societies. We will continue to engage federal authorities and remain active on Capitol Hill to ensure that the payment system is fair and appropriate, and, most importantly, that IR’s voice is heard.

Are we at a financial tipping point for the specialty of interventional radiology? Interventional radiologists deliver high-quality care in a financially sustainable environment, so there’s no doubt that we will thrive in the evolving health care system. The end products that IR delivers with image-guided interventions (less risk, less pain, less recovery time, less expensive, same-day treatments, fewer readmissions) remain critical attributes for new health care delivery models. We support patient-centered outcomes research, which will educate patients and help them make better medical decisions.

Creating and meeting this demand for medical care quality is a golden opportunity for IR during the transition from fee for service to reimbursement directly linked to quality. IR is a distinct and valuable medical specialty. We are seeking to differentiate IR from other specialties, proving how it is a true game changer in the health care system.

You will hear more about how we are in the process of clearly redefining who we are in this new health care setting, strategically following our North Star—ensuring constant access to and delivery of longitudinal high-quality, image-guided patient care.

We need more than a few good men and women to actively assist our coding/health policy efforts. Please consider volunteering your time and talents (703-691-1805).

Cultivating Clinical Practice

By Scott C. Goodwin, MD, FSIR
SIR President
Fall 2013 

Interventional radiologists routinely provide longitudinal care, engage in multidisciplinary quality initiatives and integrate disease-specific knowledge and expertise to provide outstanding patient care. This is SIR’s strategic goal when it comes to you—our members—and clinical care.

 We know that we want all health care providers to routinely and directly rely on and value our expertise as clinical care experts, leaders and providers of image-guided therapy. We want to be recognized as a critical component of the health care system, playing an integral part as leaders in hospital decision-making at all levels. We want robust admitting services and mature office practices. How do we reach this envisioned future? How do we ensure that IR becomes the first choice for image-guided therapy?

 One way we are answering these questions is by engaging in strategic collaborations with health care professionals. Specifically, SIR is working with the American College of Radiology (ACR), which over the years has endorsed IR’s clinical patient-centered nature—recognizing that we need an office presence, time allocated to see patients, time to consult with referring physicians and time to see patients on the ward. Last year, SIR was instrumental in the passage of an ACR resolution to develop implementation and marketing tactics to help optimize the clinical practices of IR and interventional neuroradiology (INR). An educational campaign to promote and demonstrate the value of IR and INR clinical practices to all important stakeholders is a principal component of the multipronged effort. 

The Interventional Radiology (IR) and Interventional Neuroradiology (INR) Clinical Practice Task Force was formed last summer with a diverse set of medical professionals, representing SIR, ACR and the Society of NeuroInterventional Surgery (SNIS). The task force, which is chaired by Philip Cook, MD, FACR, FSIR, has a steering committee and six subcommittees (INR/IR Spine, MSK and Pain Management; Neurointerventional Vascular; General IR and Interventional Oncology; Clinical IR Vascular; Education and Training; and Finance and IT).

Task force members have explored these questions: What are barriers to the clinical practice of IR/INR? What can be done to ensure the successful future of IR and INR? Forty national IR and INR thought leaders examined topics such as the adequacy of the clinical training model, the resistance of IR physicians to be more involved in longitudinal patient care, and the need to be seen as drivers of new health care delivery models and as part of the clinical infrastructure future. They crafted a draft multiphase action plan, which is being submitted to the Board of Chancellors, ACR’s executive body, for review and revision this fall. Once implemented, the action plan will first add clarity to the definition of IR clinical practice. It will then address the further establishment of the value of IR, clinical education, the creation of financial models to address financial sustainability and patient access to IR, and increasing the awareness of the importance of IR and INR to major stakeholders.

I want to thank all the members of this important task force and subcommittees who have been involved with this ambitious undertaking. While we are members of the medical house of radiology, we are also hands-on clinicians who are known as innovative problem solvers and critical resources in tough medical situations. We have a unique skill set comprised of competency in diagnostic imaging, image-guided procedures and periprocedural care. ACR’s support comes at an important time—it comes on the heels of the ABMS’s recognition of IR as a primary specialty in medicine that was a very important step in the formalization of the interventionalist’s clinical role. Forty years ago we worked as the “specialists’ specialist,” helping other doctors manage their patients with the most difficult problems. While those physician relationships remain strong, we have now taken a position in the front line of medical care.

That’s where we need to be for patients.