RSNA: Are rad assistants getting pushed out of radiology?

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CHICAGO--While radiologist assistants (RAs) could potentially increase productivity and revenue within a practice, current reimbursement and licensure restrictions are constricting the field, based on a Nov. 28 presentation from Christine J. Lung, RT, vice president of government relations and public policy for the American Society of Radiologic Technologists (ASRT), at the annual Radiological Society of North America (RSNA) conference.

Currently, there are 200 American Registry of Radiologic Technologists (ARRT)-certified RAs. The highest populations are in Florida (21), Pennsylvania (15), California (13) and Texas (13). However, these statistics are not directly related to licensure freedoms. Florida is a RA licensure state; however, in Pennsylvania, RAs work under the physician delegation statute and in Texas and California, there is only partial licensure for RAs. Also, there are more than 380 Certification Board for Radiology Practitioner Assistants (CBRPA)-certified radiology practitioner assistants. Lung also noted that more RPAs are seeking certification from the ARRT.

In fact, based on an electronic poll taken of the audience in attendance, 52 percent was certified by the ARRT, with 16 percent certified by radiologist as the next highest stat.

Lung explained that the professional landscape has drastically altered over the past few years, as fewer radiologists are retiring and the shortage is abating. Concurrently, the radiologic technologist workforce is at full employment with new graduates having difficulty findings jobs, while other medical specialties are exploring hiring radiologist extenders or training ancillary personnel to perform imaging exams/procedures, such as physician assistants (PA) and nurse practitioners (NP).

“With fewer opportunities available, it will be incumbent upon the RA to demonstrate appreciable benefit to radiology practices, as well as to be able to compete with PAs and NPs,” said Lung, adding that PAs and NPs are “well-known entities” within the medical community and the state regulatory environment.

Currently, 28 states license, regulate or otherwise recognize RAs. While some states recognize both the RRA and RPAs, others are still working toward better acceptance. Plus, Alabama has prohibited radiology extenders—RAs and RPAs—from practicing in that state.

State licensure is becoming “increasingly important” and provides protection and legal recognition for radiologist extenders, according to Lung, who points to myths that the RAs are simply an extension of RTs. Now, some facilities are requiring state licensure for credentialing or privileging. Also, some private payors or third-party payors include licensure as a condition of payment, but not the Centers for Medicare & Medicaid Services (CMS).

“RA practice is not an extension of RT practice,” Lung stressed. “RAs provide services that are widely different from RTs, and the RA practice widely surpasses any RT scope of practice, which is why we really need legal authority to practice.”

The supervision levels continue to be a “very large problem” for RAs, Lung said. CMS has extended the supervision levels to hospital-based procedures—beyond physician offices and diagnostic imaging centers—as part of the HOPPS 2010 update. When CMS requested comments on the 2010 Physician Fee Schedule in July 2009 on the practice of RAs, the ASRT, ARRT, American College of Radiology (ACR) and National Society of Radiology Practitioners (SPRE) submitted documentation on the scope of practice, examination process and the educational process, but the agency took no action. The societies also have held numerous meetings (20-25) with CMS on this issue. At this time, CMS still is not taking action to rectify the HOPPS 2010 update.

Another reimbursement concern to RAs is that PAs and NPs can receive reimbursement for procedures up to 85 percent, and they are not held to the personal supervision requirement for those same codes, explained Lung. “As a result, some practices are refusing to hire RAs until the reimbursement issue is settled, and RAs are losing jobs and some programs are not accepting students because of it,” she said.

According to a second electronic poll of the audience, 78 percent said the top professional challenge facing RA is billing/reimbursement issues. The second-voted top issue was state licensure, according to 14 percent of the audience.

Other extenders, such as PAs and RNs, are seeking to amend state laws to allow them