Advanced Practice Clinicians Order More Diagnostic Imaging

Advanced practice clinicians (APCs) are more likely to order diagnostic imaging following an outpatient office visit than are primary care physicians (PCPs), according to a study published in JAMA Internal Medicine.

Researchers from the Harvey L. Neiman Health Policy Institute, in Reston, VA, George Mason University in Fairfax, VA, and Emory University School of Medicine in Atlanta, GA, conducted a retrospective analysis of Medicare fee-for-service claims to compare the use of diagnostic imaging ordered by APCs and PCPs in order to determine the level of use.

Data from 2010 to 2011 Medicare claims were used for a 5% sample of beneficiaries. The researchers found that APCs ordered imaging in 2.8% of episodes, while PCPs ordered them in 1.9% of episodes, resulting in 0.3% more images per episode among the APC patients. “Advanced practice clinicians were associated with increased radiography orders on both new and established patients, ordering 0.3% and 0.2% more images per episode of care, respectively,” they wrote.

The researchers also noted in the article that not all states allow nurse practitioners to order diagnostic testing: 33 states allow them to refer patients for testing and only 20 allow the practitioners to order the tests.

“Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M [evaluation and management] office visits,” the researchers concluded. “While increased use of imaging appears modest for individual patients, this increase may have ramifications on care and overall costs at the population level.”