Non physician Providers are Interpreting More Imaging Studies

10 November 2019 - Ci Magazine
Non-physician providers interpreting imaging studies

According to a recent long-term study published in the American Journal of Roentgenology, nonphysician providers (NPPs) such as nurse practitioners and physicians’ assistants, are performing more imaging-guided procedures and reading an increased number of imaging examinations. Although the actual percentage of studies the NPPs are reading remains small, radiologists have explicitly agreed that “image interpretation by radiology physician extenders is not appropriate.”

Objective, Materials and Methods of the Study

The study was conducted by The Harvey L. Neiman Health Policy Institute (HPI). The researchers noted that NPPs have an increasing role in performing imaging-guided procedures, but their roles in interpreting imaging had not been studied. Therefore, the objective of the study was to analyze the role of NPPs in interpreting the results of imaging-guided procedures.

Valeria Makeeva, M.D. of Emory University in Atlanta led the research team. She reported that they used Medicare data from 1994-2015 to analyze all diagnostic imaging services, including those billed by NPPs. The services were then categorized by imaging modality and body region. Next, the annual total and relative utilization rates were calculated. The researchers also analyzed the files to determine state-level variations in NPP billing for diagnostic radiology services.

Radiologist Concerns and Study Results

Makeeva noted that “National radiology societies have opined that imaging interpretation should fall entirely within the domain of radiologists rather than NPPs.”  Although the study discovered that the number of diagnostic imaging studies increased by 24 percent during the time period studied, interpretation services billed by NPPs increased only slightly. In 1994, NPPs billed for only 0.01% of diagnostic imaging services. In 2015, it had increased only to 1.27% of all such services.

Makeeva explained that when NPPs do perform diagnostic imaging exams, across all years that were studied, they are more often “radiography and fluoroscopy.” These accounted for 94 percent of all NPP billed services between 1994 and 2015. This still represented only 0.01% for 1994 and increasing to only 2.1% in 2015 of NPP billing across all Medicare RF services.

The study revealed that there is “considerable state-to-state variation” in the number of diagnostic imaging services billed by NPPs, likely due to state practice laws and regulations. Even then, the rates of NPPs performing diagnostic services remains low. South Dakota and Alaska had more NPP diagnostic-billed imaging than any other state. The least common states for NPP diagnostic-billed imaging were Hawaii and Pennsylvania. As found in the overall study, the states that had the most NPP diagnostic imaging were for x-ray and fluoroscopy.

The researchers concluded that “Despite increasing roles of NPPs in health care across the United States, NPPs still rarely interpret diagnostic imaging studies. When they do, it is overwhelmingly radiography and fluoroscopy.”

Richard Duszak, M.D., FACR, professor of radiology and imaging sciences at Emory University and senior affiliate research fellow at the Harvey L. Neiman Health Policy Institute, and one of the researchers who participated in the study, was quoted in the HPI press release announcing the results of the study as concluding that “[a]t present, the near-term likelihood of NPPs acquiring substantial diagnostic imaging market share is extremely low.”