Non-Physicians Are Reading More Medical Images

Non-physician practitioners are reading more medical images in U.S. medical offices. That’s according to a new study in JACR by researchers who found that the share of images interpreted by NPPs has doubled in the last 10 years. 

In the U.S., radiologists consider themselves to be the primary interpreters of medical images, but inroads have been made not only by other physicians but also by non-physician practitioners like nurses and physician assistants. 

  • NPPs are supposed to receive specialized training in image interpretation, but radiologists question whether such training is adequate, especially compared to the years of training that radiologists receive. 

Previous research has documented the rise in NPP image interpretation, but the new study takes a longer view, examining the period 2013-2022. 

  • It also specifically focuses on the medical office setting, where it’s believed NPP interpretation is growing faster than in hospitals, where radiologists still dominate interpretations. 

In their analysis of Medicare claims, researchers from the ACR’s Harvey L. Neiman Health Policy Institute found … 

  • NPPs’ share of office-based image interpretations grew 9% annually (2.5% to 5.5%).
  • Growth rates varied by modality, with MRI growing at 9.9% annually, followed by CT (9.4%), ultrasound (9.4%), radiography (8.9%), and nuclear medicine (7.2%).
  • Despite the growth, just 5.6% of NPPs were interpreting images.
  • By specialty, the share of NPP interpretation was most common with primary care (40%) and orthopedic offices (34%).

The researchers also tracked variability in NPP interpretation rates by state, finding the highest rates ( ~13%) in Western states with large rural areas like Montana, Alaska, and Idaho, where presumably there are fewer radiologists available to read images. 

The Takeaway

The findings provide a good news/bad news look at non-physician image interpretation. The good news for radiologists is that NPP interpretation is still pretty rare; the bad news is that rates are growing quickly. And given the ongoing radiologist shortage, there is sure to be continuing pressure to allow allied health staff to read images on their own.

Radiology’s Nonphysician Service Expansion

A new Harvey L. Neiman study showed that the recent expansion of nonphysician practitioners (NPPs) across US radiology practices coincided with similar increases in NPP-billed services — services that have traditionally been performed and billed by radiologists.

The Study – Researchers reviewed 2017-2019 data for Medicare claims-submitting nurse practitioners and physician assistants (together “NPPs”) who were employed by US radiology practices, finding that:

  • The number of radiology-employed NPPs who submitted claims increased by 16.3% between 2017 and 2019 (523 to 608 NPPs), while the number of US radiology practices that employed claims-submitting NPPs jumped by 14.3% (196 to 224 practices)
  • This NPP service expansion was driven by clinical evaluation and management services (E&M; +7.6% to 354), invasive procedures (+18.3% to 458), and image interpretation services (+31.8% to 112).
  • Meanwhile, total NPP wRVUs increased by 17.3%, similarly driven by E&M services (+40% to 111k wRVUs), invasive procedures (+5.6% to 189k), and image interpretation (+74% to 8,850 wRVUs)
  • Some radiologists might be concerned that image interpretation saw the greatest NPP headcount and wRVU growth (see +31.8% & +74% stats above), although imaging only represented a small share of overall NPP wRVUs (2.9% in 2019), and 86.7% of NPP-submitted imaging services were for either DEXA scans or swallowing studies. 

The Takeaway

Although roughly 87% of radiology practices still don’t employ NPPs who submit Medicare claims (as of 2019 anyway), this study reveals a clear trend towards NPPs performing more billable procedures — including image interpretation. 

Given previous evidence of NPPs’ growing employment in radiology practices and the major role NPPs play within other specialties, this trend is very likely to continue, leading to more blended radiology teams and more radiologist concerns about the NPP ‘slippery slope.’

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