Medicare Claims Study Shows Increasing Utility of PAs and NPs in Radiology Practices

With the increasing number of radiology practices that employ nurse practitioners (NPs) and physician assistants (PAs), new research reveals corresponding increases in Medicare claim submissions for evaluation and management (E&M) services, procedures and imaging services provided by NPs and PAs (NPPs).

Comparing Medicare data sets from 2017 and 2019, the study authors noted a 16.3 percent increase in the number of NPPs in radiology practices who submitted claims to Medicare. The researchers noted a 40 percent increase in Medicare work relative value units (wRVUs) for clinical E&M services provided by NPPs, a 5.6 percent increase for invasive procedural wRVUs for NPPs and a 74 percent increase for non-invasive imaging interpretation services for NPPs, according to the study, which was published in the Journal of the American College of Radiology.

The study authors said another emerging trend may be an increasing number of radiologist-employed NPPs who spend the majority of their work hours on image interpretation. Noting a 62.1 percent increase in the number of radiology practices employing these NPPs (from 41 practices in 2017 to 66 practices in 2019), the researchers found that the number of NPPs performing any image interpretation services increased 31.8 percent from 2017 (85) to 2019 (112).

“Over all 3 years, a majority of radiologist-employed NPPs performed invasive imaging-guided procedures and E&M services. Although only a small minority of radiologist-employed NPPs billed for imaging interpretation, relative growth for imaging interpretation was greatest across all three categories,” wrote study co-author Richard Duszak, Jr., M.D. a professor and chair of the Department of Radiology at the University of Mississippi Medical Center in Jackson, Miss., and colleagues.

Noting the increasing volume and complexity of interventional radiology procedures, the researchers said an associated growth in related E&M services performed by NPs and PAs also appears to be on ongoing trend in this subspecialty.

“NPPs have been described as part of a team-based approach, within regulatory confines, to grow an interventional radiology practice’s clinical presence,” noted Duszak and colleagues. “We believe that the observed growth of E&M services tendered by radiologist-employed NPPs, particularly in light of increased employment of NPPs by radiology practices with larger interventional practices, reflects ongoing adoption of such team-based interventional radiology care.”

Over 73 percent of PAs were predominantly proceduralists in 2017 and 2019, according to the study. The researchers noted the majority of NPs in radiology practices primarily performed clinical E&M services (65.8 percent in 2017, 58.8 percent in 2019).

In regard to study limitations, the study authors noted it was unclear from the Medicare claims data whether the services billed by NPs and PAs were performed independently or with some measure of oversight from a radiologist. They acknowledged the possibility of excluding work by some NPS and PAs who performed a smaller number of services as the Centers for Medicare and Medicaid Services (CMS) reporting does not include service fields with 10 or fewer counts. Duszak and colleagues also noted the study findings may not be applicable for NPs and PAs who work in multispecialty groups nor radiologist assistants who work in radiology practices.