Original articleExpanding Roles of Nurse Practitioners and Physician Assistants As Providers of Nonvascular Invasive Radiology Procedures
Introduction
Although much attention in health care reform discussions has focused on cost and quality, access to health care services remains a critical public policy issue. Many US citizens face challenges achieving timely access to health care services, and this disproportionately affects minorities, those with lower incomes, and those residing in rural areas [1]. With a US population that is both growing and aging, and a funding-constrained graduate medical education system little able to expand, some are predicting that the country’s demand for physician services may soon exceed its physician supply 2, 3.
Formerly termed midlevel practitioners, advanced practice providers (APPs) likely will be an integral component of the solution to this predicted provider-access gap. Primarily representing nurse practitioners (NPs) and physician assistants (PAs), this professional group is in increasing demand by medical practices and health care systems nationwide [4]. Much attention has focused on the expanding roles of APPs in the primary care setting 5, 6, but involvement of APPs in critical care, surgery, and a variety of other specialty services is increasing as well 7, 8, 9.
Interventional radiology practices are increasingly utilizing APPs to provide both clinical and procedural services 10, 11, 12. With regard to the latter, a dramatically expanded role of APPs as providers of central venous access services has recently been reported [13]. We believe that the role of APPs as primary operators for a variety of minor nonvascular invasive procedures historically performed by radiologists has expanded dramatically as well. To our knowledge, however, this hypothesis has not been tested using national administrative claims or registry data. Our aim, therefore, is to study the expanding role of APPs as providers of invasive procedures commonly performed by radiologists, using aggregated Medicare claims files.
Section snippets
Methods
This HIPAA-compliant study of aggregated Medicare claims data from CMS-designated public use files was deemed to be exempt from review by our institutional review board. Our goal was to identify categories of nonvascular invasive radiology procedures that are potentially representative of the spectrum of those performed nationally by APPs. Thus, we reviewed deidentified procedure summary volume data for fiscal year 2013 (September 1, 2012 through August 31, 2013) from the 2 largest hospitals in
Results
Of 1,352 nonvascular procedures performed by APPs at our facilities in 2013, a total of 1,161 (85.9%) were included in the 7 defined categories. Paracentesis (40.1%; 471 of 1,161); fine-needle aspiration (FNA; 24.2%; 285 of 1,161); abdominal biopsy (19.0%; 223 of 1,161); and thoracentesis (5.4%; 124 of 1,161) together comprised 89.8% of these categorized procedures (Table 1).
Discussion
We used national Medicare claims data from 1994 through 2012 to study the expanding role of APPs as providers of minor nonvascular invasive procedures common to radiology practices. In all 7 procedure service categories studied, paid Medicare claims—zero for 4 of 7 categories in 1994—increased dramatically. Depending on the particular service category, APPs now perform between 1% and 11% of these procedures nationwide. Radiologists, in comparison, perform as many as 97%.
Expanding roles of APPs
Take-Home Points
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Although APPs nationally perform a relatively small portion of the nonvascular invasive procedures commonly performed by radiologists, paid Medicare claims for those services have increased dramatically over nearly 2 decades, and at a faster pace than for all providers as a whole.
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Depending on the particular category of service, APPs nationwide now perform between approximately 1% and 11% of nonvascular invasive procedures commonly performed by radiologists.
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Given the numerous hurdles involved in
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Policy perspectives
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