NPPs perform less than two percent of diagnostic imaging services

Less than two percent of NPPs perform diagnostic imaging services despite a rise in such roles, says a new study

September 20, 2019
by John R. Fischer , Staff Reporter
Less than two percent of nurse practitioners and physician assistants (NPPs) perform diagnostic imaging services despite Medicare claims data indicating a rise in these roles for such procedures.

That’s the consensus of scholars within the American Roentgen Ray Society, who found that when NPPs do render such procedures, they are overwhelmingly radiography and fluoroscopy.

“At present, the near-term likelihood of NPPs appropriating substantial market share in diagnostic imaging is very low,” said Emory University researcher Valeria Makeeva in a statement.

As part of their research, Makeeva and her colleagues assessed all diagnostic imaging services recorded in the Medicare Physician/Supplier Procedure Summary Master Files from 1994-2015, cataloging them by modality and body region. They used the 2004-2015 Medicare Part B 5% Research Identifiable File Carrier Files to separately assess state-level variation in the procedures performed by NPPs, with total and relative utilization rates calculated annually.

They found that diagnostic imaging services rose by 24 percent from 339,168 to 420,172 per 100,000 Medicare beneficiaries between 1994 and 2015 and those performed by NPPs also increased 14,711 percent from 36 to 5332 at the same rate. Despite these upward trends, services performed by NPPs made up a mere 0.01 percent of all imaging in 1994 and 1.27 percent in 2015.

Radiography and fluoroscopy made up the bulk of NPP-billed imaging services at 94 percent in both years and remained constant at 0.01 percent and 2.1 percent for all Medicare radiography and fluoroscopy services, respectively. Absolute annual service counts for NPP-billed radiography and fluoroscopy services, however, increased from 10,899 to 1,665,929 during this time span.

The team found South Dakota to be the most common state for NPP-billed imaging at 7,987 services per 100,000 beneficiaries, followed by Alaska at 6,842. The least common were Hawaii at 231 services and Pennsylvania at 478 services.

Makeeva says a likely contributor to these low numbers of NPP-billed services is the unique scope-of-practice laws and regulations in different states.

“Our work shows the need for NPP employers to consider formally defining potential NPP roles within radiology services through NPP training programs that comport with NPP scope of practice in their specific states,” she said.

The findings were published in the American Journal of Roentgenology.

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