Nonphysician provider imaging rates higher than that of primary care doctors

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Advanced care practitioners are 34 percent more likely than a primary care physicians to prescribe an imaging exam, according to a study published Nov. 24 in JAMA Internal Medicine.

Led by Danny R. Hughes, PhD, of the Harvey L. Neiman Health Policy Institute in Reston, Va., the researchers sought to look into the frequency of diagnostic imaging procedures ordered by advanced care practitioners, like nurse practitioners and physician assistants, relative to the number ordered by primary care physicians in office-based encounters.

The authors noted warnings of “worsening primary care physician shortages” in the wake of increased health care demands and recent Affordable Care Act stipulations. One method of alleviating primary care physician shortages is by expanding the scope of practice for “nonphysician providers,” like advanced care practitioners.

But despite the potential that lies in alleviating the patient load of physician providers, not much is known regarding the advanced care practitioners’ use of related services, like diagnostic imaging, where patient cost and radiation exposure is likely to increase.

“We sought to examine the use of diagnostic tests—specifically medical imaging—by [advanced care practitioners] as a directly observable and quantifiable measure for comparing the care they provide with that of [primary care physicians],” Hughes and colleagues wrote.

For the study, the team examined 2010-2011 Medicare claims for a 5 percent sample of beneficiaries. They compared diagnostic imaging exam rates between advanced care practitioners and primary care physicians using specialty codes to differentiate procedures.

The team found that nonphysician providers ordered more diagnostic imaging than primary care doctors following outpatient visits, specifically 2.8 percent and 1.9 percent of episodes respectively.

They found that advanced care practitioners were associated with increased radiology orders on both new (0.3 more images per episode of care) and established (0.2 more images per episode of care) patients than their primary care counterparts.

“While the increased use of imaging appears modest for individual patients, this increase may have important ramifications on care and overall costs at the population level,” the study authors wrote.

Hughes and team noted that greater coordination between advanced care practitioners and primary care doctors may produce outcomes for the healthcare industry, rather than attempting to fill shortage voids left by primary care doctors alone.