There has been a dramatic rise in nurse practitioners and physician assistants performing certain image-guided procedures, according to an analysis published Thursday.
In particular, NPs and PAs have grabbed a growing share of Medicare reimbursement for the removal of fluid or gas from the lungs (thoracentesis) and abdomen (paracentesis).
Radiologists performed the majority of ultrasound-guided thoracentesis at nearly 74% in 2013. But their total share fell to 66% by 2018, during a time when advanced practice providers saw their share rise leap from 8% up to nearly 13%.
“The most striking trend in this study is the dramatic increase in volume of these procedures performed by APPs, which approximately doubled over the study period,” Rajoo Dhangana MD, a professor and interventional radiologist with the University of Pittsburgh Medical Center, and co-authors wrote March 24. “The great acceleration of this trend in the past decade, demonstrated in the present study, follows a national trend of increasing participation of APPs in clinical care, specifically in minimally invasive procedures,” they added later.
Researchers gathered their data from 2012-2018 Medicare claims for procedures performed with and without imaging guidance. Such “blind” delivery of thoracentesis decreased nearly 44% during the study period, down to 15,000 procedures in 2018. Meanwhile, the volume of imaging-guided needle insertion into the pleural space around the lungs climbed 19%, up to almost 223,000 during the same time.
Blind paracentesis volume also dropped during the study period, falling almost 30%, down to 12,000. On the other side, the volume of imaging guided, needle-based sampling of fluid from the peritoneal cavity leapt 48%, up to nearly 254,000 during the same time. Similar to thoracentesis, radiologists held the dominant share, delivering 84% of these procedures in 2012, which fell down to 77% by the end of the study period. APPs saw their own share increase “dramatically” from 10% up to 16%.
Hospitals and radiology departments have recognized the value of APPs performing minimally invasive procedures, the study authors noted. They can bill Medicare at about 85% of what physicians charge, with a salary at about one-third of radiologist pay.
“Therefore, having an increasing share of procedures safely performed by APPs can decrease costs and increase revenue for healthcare systems by freeing radiologists to perform a greater volume of image interpretation or more complex procedures,” Dhangana et al. wrote.
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.