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.
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.’
A new JACR study detailed nonphysician practitioners’ (NPPs) expansion across US radiology practices, mirroring a trend already seen in other parts of healthcare and raising questions about how much further radiology NPPs might expand.
The Study – The study reviewed 2017-2019 Medicare data for nurse practitioners and physician assistants (together “NPPs”) employed by US radiology practices, finding that:
- Radiology practices employing NPPs increased by 10.5% (228 to 252 practices), while the number of overall radiology practices declined by 36.5% (2,643 to 1,679)
- As a result, the share of radiology practices with NPPs on staff nearly doubled (8.6% to 15% of US practices)
- NPP-employing practices expanded their NPP workforce at a much faster rate (+17.5%, 588 to 691) than they added radiologists (+10.4%, 6,596 to 7,282)
- The growth of urban practices employing NPPs (10% to 17% share) significantly outpaced rural practices (5% to 7% share), despite a greater need for radiology coverage in rural areas
- Radiology practices were also more likely to employ NPPs if they were larger, staffed more interventional radiologists, or had a high number of early-career radiologists
The study was limited to radiology-only practices, which employ two-thirds of U.S. radiologists, but excludes many academic, hospital-employed, and multi-specialty groups. That said, it’s possible that radiology NPP growth would be even greater if these groups were included.
Although 85% of practices didn’t employ NPPs and radiologists still outnumbered NPPs by a 32:1 ratio (as of 2019 anyway), this study reveals a clear trend towards more practices employing NPPs and rising overall radiology NPP headcounts. That’s probably not surprising given the historical growth of NPPs within other specialties, and radiology’s continued shift towards national and PE-owned practices, but it’s still interesting to see how it’s taking place.
It’s also interesting that this study wasn’t met with the level of radiologist uproar that we saw the last few times radiology NPPs made it into the industry news cycle. Even though NPPs’ expansion across radiology practices doesn’t mean that they will start encroaching into radiologists’ clinical territory (as some rads fear), it does suggest that we’ll see a lot more blended rad/NPP workforces going forward.