Nonphysician providers (NPPs) such as nurse practitioners and physician assistants are playing a bigger role in providing imaging-guided procedures across the U.S. But they seldom interpret diagnostic images, according to a study published online September 11 in the American Journal of Roentgenology.
However, when they do provide this service, it's usually for x-ray and fluoroscopy, wrote a team led by Dr. Valeria Makeeva of Emory University School of Medicine in Atlanta.
"NPP roles in rendering diagnostic imaging interpretation services across the United States are increasing," the group wrote. "However, when compared with the overall numbers of diagnostic imaging interpretations, NPPs still rarely render diagnostic imaging services. When they do, it is most frequently for radiography and fluoroscopy."
Despite their increased involvement in assisting with imaging-guided procedures, the role of nonphysician providers in interpreting imaging exams has received little attention, according to Makeeva and colleagues.
"NPP roles in interventional radiology and other procedure-based settings have been well documented," the group wrote. "However, the literature investigating NPP roles in diagnostic radiology has been limited to proof-of-concept studies evaluating NPP performance in imaging interpretation and their effects on radiologist throughput ... the frequency with which NPPs provide diagnostic radiology services nationally and regionally is unknown."
To address this knowledge gap, the researchers used Medicare Physician/Supplier Procedure Summary Master Files from 1994 to 2015 to identify all diagnostic imaging services, including those billed by nonphysician providers. The group categorized these by modality and body region and then evaluated state-level variation in imaging services provided by nonphysician providers.
The team found the following:
- Between 1994 and 2015, diagnostic imaging services per 100,000 Medicare beneficiaries increased by 24%.
- Diagnostic imaging services provided by nonphysician providers increased 14,711% during the same time frame, but they still constituted only 0.01% of all imaging in 1994 and 1.27% of all imaging in 2015.
- X-ray and fluoroscopy made up most of the nonphysician provider-billed imaging services and remained constant over time, representing only 0.01% and 2.1% of all Medicare radiography and fluoroscopy services.
- Nonphysician provider-billed imaging was most common in South Dakota and Alaska and least common in Hawaii and Pennsylvania.
The study results suggest a "need for standardized, narrowly focused, highly supervised, and imaging-specific training programs for these professionals -- such as those that exist for radiologic technologists aspiring to become radiologist assistants," Makeeva said in a statement released by the American Roentgen Ray Society (ARRS).
"Our work shows the need for NPP employers to consider formally defining potential NPP roles within radiology services through ... training programs that comport with NPP scope of practice in their specific states," she said.
