The roles of non-physician practitioners (NPPs) will inevitably continue to grow in healthcare, but how will their presence impact radiology?
In a newly published paper in Current Problems in Diagnostic Radiology, author Robert Martin, MPH, of Rowan University School of Osteopathic Medicine in New Jersey, notes that an "imaging happy healthcare system” has placed a huge demand on the shoulders of radiologists in recent years, making it difficult for them to keep up with their workloads. At the same time, the presence of NPPs has grown exponentially, yet their integration into radiology practices has been slower than in other specialties.
“Despite the growing imaging demand and radiologist related procedures, the availability of radiology practices and radiologists continues to fall short of demands,” Martin explained.
Martin suggests that, when properly trained, integrating NPPs—nurse practitioners and physician assistants—into radiology workflows could provide solutions for many issues in the field while promoting greater work-life balance for radiologists.
There are, however, considerations that need to be made regarding increasing the presence of these providers in radiology, Martin noted.
Below are his observations, derived from literature on the subject, on how NPPs can be integrated into radiology practices in a way that will benefit all parties involved:
Radiology-specific training. Although there is radiology-specific training for radiology assistants (who are already included in radiology workflows), including several years working alongside radiologists as a technologist, there is currently no standardized radiology-specific training for other general NPPs. A training program that provides detailed information and direct guidance could address this. Martin notes that a "well-defined training regimen, alongside a strict scope-of-practice clarified by supervising radiologists" could help to streamline the integration process.
Reporting structures. This would optimize communication between NPPs and radiologists and can be organized based on practice size. For example, at small practices, one to two NPPs could report to one designated radiologist.
Time-driven activity-based costing (TDABC). This involves pairing NPPs with procedures or studies that align best with their skills. This would give radiologists more time to focus on higher RVU imaging and improve overall workflow efficiency.
Reimbursements. For procedures, nurse practitioners and physician assistants can both bill for an 85% reimbursement in the Medicare Physician Fee Schedule (MPFS), but billing structure with radiology assistants differs. In-room supervision from a physician increases this rate to 100%. However, reimbursements for NPPs and procedures vary by state, and the billing process can be confusing, Martin notes.
Supplemental services. NPPs can triage patients, screen them for appropriateness of imaging, schedule exams, complete inpatient consultations and more. Some of these services that are not billed for or are “under billed” by physicians can be billed for by NPPs, creating additional revenue.
Excess imaging. Previous research has indicated that some NPPs order imaging in excess compared to their physician peers. Martin suggests that proper radiology-specific training (mentioned above), in addition to various ACR resources could help address this.
Martin notes that, although radiologists currently and will continue to complete the vast majority of the work in radiology, proper NPP integration can “promote the opportunity to take tedious tasks and/or cases from overworked radiologists/physicians to pursue greater profits and work-life balance.”
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.