title: Expanding roles of nurse practitioners and physician assistants as providers of nonvascular invasive radiology procedures.
abstract: OBJECTIVE
  To evaluate national trends in nonvascular invasive radiology procedures performed by advanced practice providers (APPs), focusing specifically on nurse practitioners and physician assistants.
  
  
  METHODS
  Nonvascular invasive radiology procedures commonly performed by APPs at our 2 largest hospitals were used to identify procedure groups for national trends analysis. We mapped categories of services annually to then-current Current Procedural Terminology codes from 1994 to 2012 and identified national Medicare Part B beneficiary paid claims frequency using Physician Supplier Procedure Summary Master Files. Trends were studied for APPs, radiologists, and all providers nationally for 7 categories of service: paracentesis, thoracentesis, fine-needle aspiration (FNA), superficial lymph node biopsy, abdominal biopsy, thoracic biopsy, and abdominal drainage.
  
  
  RESULTS
  Of 1,352 nonvascular invasive procedures performed by APPs at our facilities over a 1-year period through August 2013, a total of 1,161 (85.9%) fell into the 7 defined categories. Between 1994 and 2012, national Medicare claims by APPs increased dramatically for all of these categories: paracentesis from 0 to 17,967; thoracentesis from 119 to 4,141 (+3,379%); FNA from 0 to 3,921; superficial lymph node biopsy from 0 to 251; abdominal biopsy from 1 to 1,819 (+1,818%); thoracic biopsy from 0 to 552; and abdominal drainage from 37 to 410 (+1,008%). Overall, volumes increased for both radiologists and all providers, with the total fraction of national services performed by APPs increasing from 0% to 10.7% for paracentesis, 0.1% to 5.7% for thoracentesis, 0% to 2.1% for FNA, 0% to 1.4% for superficial lymph node biopsy, 0% to 1.7% for abdominal biopsy, 0% to 1.0% for thoracic biopsy, and 0.1% to 1.2% for abdominal drainage.
  
  
  CONCLUSIONS
  Although APPs perform a relatively small portion of commonly performed nonvascular invasive radiology procedures nationally, paid Medicare claims for those services have increased dramatically over nearly 2 decades, and at a faster pace than that for all providers as a whole. Given the multiple hurdles involved in obtaining Medicare reimbursement, that growth indicates increasing acceptance of APPs as procedure service providers at the institutional credentialing, state licensure, and payer policy levels.
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia. Electronic address: richard.duszak@emory.edu.
authors.forename: Richard
authors.initials: R
authors.lastname: Duszak
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; College of Nursing, University of South Alabama, Mobile, Alabama.
authors.forename: D Gail
authors.initials: DG
authors.lastname: Walls
authors.affiliation: Department of Biology, University of Central Arkansas, Conway, Arkansas.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Wang
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hemingway
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Health Administration and Policy, George Mason University, Fairfax, Virginia.
authors.forename: Danny R
authors.initials: DR
authors.lastname: Hughes
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: William C
authors.initials: WC
authors.lastname: Small
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bowen
mesh_terms: D007587:Job Description; D009722:Nurse Practitioners / Q000706:statistics & numerical data* / Q000639:trends*; D010823:Physician Assistants / Q000706:statistics & numerical data* / Q000639:trends*; D024382:Professional Role; D015641:Radiography, Interventional / Q000706:statistics & numerical data* / Q000639:trends*; D014481:United States; D016526:Workload / Q000706:statistics & numerical data
keywords: Advanced practice providers; biopsy; drainage; imaging guided procedures; interventional radiology; midlevel practitioners; nurse practitioners; physician assistants