Nonphysician providers find growing role in radiology practices

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Nonphysician practitioners (NPPs) are increasingly being employed by radiology practices -- they're taking on more work, according to research published August 22 in the Journal of the American College of Radiology.

After reviewing Medicare datasets from 2017 and 2019, researchers from the Harvey L. Neiman Health Policy Institute (HPI) led by Stefan Santavicca of Emory University found that the number of NPPs -- nurse practitioners and physician assistants -- who are submitting claims increased by 16.3% over the two-year period.

What's more, the aggregate Medicare fee-for-service work relative value units (RVUs) for NPPs increased by 17.3%.

In an effort to characterize the specific clinical roles of NPPs, the researchers analyzed the 2017 and 2019 U.S. Centers for Medicare and Medicaid Services (CMS) Doctors and Clinicians databases. Next, they identified services billed by NPPs and weighted them by work RVUs. The researchers then categorized the services as either clinical evaluation and management, invasive procedures, and noninvasive imaging interpretation.

Growing role of NPPs in radiology practice between 2017 and 2019
  2017 2019 Increase
Number of radiology-employed NPPs submitting Medicare claims 523 608 16.4%
Total Medicare fee-for-service work RVUs from radiology-employed NPPs 263,671 309,190 17.3%
Total invasive procedural work RVUs from radiology-employed NPPs 179,044 189,003 5.6%
Total clinical evaluation and management work RVUs from radiology-employed NPPs 79,540 111,337 40%
Total noninvasive imaging interpretative service work RVUs 5,087 8,850 74%

Most radiologist-employed NPPs perform clinical evaluation and management, as well as invasive procedures. Recently, NPPs have been described as part of a team-based approach to grow an interventional radiology practice's clinical presence, according to the researchers.

"We believe that the observed growth of [evaluation and management] services rendered by radiologist-employed NPPs, particularly in light of increased employment of NPPs by radiology practices with larger interventional presences, reflects ongoing adoption of such team-based interventional radiology care," the authors wrote.

The researchers noted that nurse practitioners were more likely to have a majority of work-related RVUs in clinical evaluation and management, while physician assistants were more likely to be focused on procedures. In addition, the most commonly performed invasive procedures were paracentesis and thoracentesis.

A small but increasing number of NPPs are also interpreting imaging, according to the researchers.

"Although such growth could increase patient access to radiology services, the implications on the radiologist workforce and patient outcomes are unknown and merit further investigation," the authors wrote.

Of the imaging interpretation services billed by NPPs, 86.7% fell into two narrow groups: bone densitometry and fluoroscopic swallowing studies. Both of these examination types have low radiologist interest and are already being assumed by other specialties, according to the researchers.

The jury is still out on the impact of these changes to radiology practice.

"Our aggregate claims-based analysis does not allow us to study comparative outcomes of services rendered by NPPs nor opine on whether the observed trends are either good or bad for the specialty or its patients," said senior author Dr. Richard Duszak of the University of Mississippi Medical Center in a statement from the Neiman HPI. "Such questions will require further study and analysis."

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