Available online 8 May 2024, 100951

Owning and operating an Office-Based Lab (OBL) creates a unique career, combining the privilege of practicing Interventional Radiology (IR) with the creativity and excitement of running a complex business. No business is more complicated than the American Healthcare system, with a combination of necessary operational systems, government and commercial reimbursement, local and national regulations, an ever-changing landscape, and various patient populations; the business is always shifting. No field is as complex and exciting as Interventional Radiology, with advanced clinical and technical expertise, device development, rocedural ingenuity, and the ability to solve complex medical problems with elegant solutions. A sole owner and operator in an OBL has full autotomy, and thus full responsibility for the medical and business aspect of the practice.

Consultant: Merit, Siemens, Abbott, Cordis

OBL's have been scattered across the country for decades. Historically, OBL's were few and far between. In 2008 Medicare increased reimbursement for outpatient procedures, driving the growth of OBL's. With the ASC/OBL market rapidly growing, lower estimates predict the OBL market to grow to $14.5 billion by 2027, with more aggressive estimates of $88.77 billion by 2023. While the dollar growth may be appealing to administrators, government and commercial payors, and the lobbyists who fight for

Procedural excellence and independent decision making is a necessity for anyone who wants to operate in an OBL, especially a sole operator. Ideally the sole owner is IR four or more years out of training, allowing for additional medical and procedural training before transitioning into an OBL. The trainee/early career IR should work hard to develop independent decision making. In sole ownership there is no attending oversight. While ‘at the elbow’ mentorship may exist in an OBL, it certainly

OBL ownership involves a strong clinical acumen. For decades there has been debate about the need for an IR to have strong clinical skills. In the OBL setting, there is no debate. If you are not a strong clinician with a decent bedside manner and an ability to connect with patients, you will not survive as a sole owner OBL. Evaluation and management (E&M) revenue will account for 5-20% of collections. The trainee should participate in an active medical clinic 1-2 times a week. Ideally, he or

Sole owners often risk everything to build their labs. Every owner/operator will tell you that they have leveraged their houses, lived without a paycheck for months and even years, and spent many sleepless nights hoping to keep the doors open. A sole operator must have the direction, vision and personal strength to bear through the first 1-3 years of great instability. Unlike in a partnership, there is no one else to absorb the bills that start coming early, far before the first patient. The

Once financing is procured, the sole operator has to find a space. The shopped space may range from an existing surgical space to a free-standing dilapidated building. Any space has potential and the sole OBL owner should look well beyond the more traditional and familiar medical office buildings. Location, community need, cost of real estate, certificate of need, and available finances all contribute to finding the perfect space to launch. The decision to lease versus buy usually comes down to

© 2024 Published by Elsevier Inc.