Volume of interventional radiology procedures performed by nurse practitioners surges 143%
The volume of interventional radiology procedures performed by nurse practitioners surged 143% over a 10-year period, according to new research published Monday in JACR.
Physician assistants also handled a growing share of treatments, with their tally increasing nearly 67% between 2010 and 2021. Overall, such advanced practice providers now perform about 15.5% of interventional radiology services analyzed or over 136,000 out of 882,275 cases in a single year, “representing an important presence in procedural practices.”
The findings are derived from an analysis of Medicare Part B claims data. Lead author Will S. Lindquester, MD, and colleagues did not attempt to unearth reasons for these trends. However, they believe financial incentives likely played a part.
“While APPs have salaries of typically one-third or less of IR physicians, they can bill Medicare under the same Physician Fee Schedule at a rate of 85% of what physicians can, potentially resulting in more than a 50% net savings in provider cost,” Lindquester, an IR specialist with Emory University’s School of Medicine in Atlanta, and co-authors wrote July 1. “APPs can also help practices generate revenue by freeing up radiologists to perform more complex and higher revenue procedures or more diagnostic image interpretation. Therefore, IR divisions can theoretically decrease costs and increase revenue by having a greater share of certain procedures performed by APPs.”
The analysis focused on interventional procedures commonly performed by nurse practitioners and physician assistants, based on previous literature. These included the image-guided placement of PICC lines, tunneled central catheters and ports, along with paracentesis and thoracentesis, fluoroscopy-based gastrostomy and gastrojejunostomy exchange, and percutaneous liver and kidney biopsies. Radiology assistants were excluded from the analysis since they do not have a unique Provider Specialty Code in Medicare databases. The authors also made multiple adjustments, due to code deletions and modifications during the study period.
NPs handled over 15,000 such IR procedures in 2010, which more than doubled in the decade that followed, up to 37,000 in 2021. PAs, meanwhile, delivered almost 60,000 IR services, which climbed to over 99,000 by the end of the study period. Growth in the total number of these procedures performed by APPs is “notable,” Lindquester and colleagues said, as the total number of these procedures performed by all provider types decreased during the timeframe.
The analysis also did not attempt to explore the safety of procedures performed by nonradiologists. However, previous studies evaluating image-guided vascular access and biopsies have demonstrated that complication rates are “comparable to physicians.”
“Moreover, APPs who are properly trained in comprehensive image-guided practices and perform consistently high volumes of procedures may be better suited to perform these image-guided procedures than some physicians from other medical specialties,” the authors noted. “For example, some nephrologists report low procedural requirements during training and overall low comfort with kidney biopsies. Therefore, the small but increasing proportion of image-guided liver and kidney biopsies performed by APPs may represent an opportunity for continued growth in procedural IR practices.”
Lindquester et al. believe these numbers likely underestimate the APP procedure totals, as many are likely performed by nurses and assistants under the direct supervision of a physician, with the billed services attributed to the doc. Read more, including potential study limitations, at the link below.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.