Non-physician practitioners (NPPs) are increasingly interpreting medical imaging studies in office-based settings, with their share of Medicare imaging interpretations rising from 2.52% in 2013 to 5.47% in 2022, according to a study by the Harvey L. Neiman Health Policy Institute.

The 117% increase was observed across over 20 million Medicare fee-for-service imaging studies analyzed in the Journal of the American College of Radiology.

The research highlights a notable growth in NPP contributions across various imaging modalities. Eric Christensen, Ph.D., research director at the Neiman Health Policy Institute, said, “We found that the NPP interpretation share more than doubled for X-ray (+114.5%), ultrasound (+124%), CT (+123.6%), and MR (+134.8%), and nearly doubled for nuclear medicine (+86.7%). This growth was fueled by a 141% increase in the number of NPPs providing care to Medicare patients over the decade (2013–2022).”

Demographic and practice variations
The study revealed several trends related to NPP characteristics and their imaging interpretation rates. Male NPPs were 61% more likely to interpret imaging than female counterparts, while younger NPPs (under 55) were 41–43% more likely to do so compared to those 65 and older. NPPs in smaller practices were also 2–3 times more likely to interpret imaging than those in larger practices.

Dr. Richard Duszak, professor and chair of the Department of Radiology at the University of Mississippi Medical Center, noted that these trends, coupled with the growing number of NPPs entering the workforce, suggest the rate of NPP imaging interpretations could continue to rise. “This raises questions about the differential adequacy of NPP training in radiology and the associated quality of their interpretations,” Duszak said.

Geographic and specialty-specific findings
The study identified significant state-by-state variations. For instance, more than 16% of X-rays in Alaska, Idaho, and Montana were interpreted by NPPs, compared to less than 1% in Hawaii. Similarly, CT interpretation rates by NPPs were above 2% in states like Utah and South Dakota, while many states reported no NPP participation in CT interpretation.

Christensen attributed these disparities to factors such as regional physician shortages and state regulations affecting NPP scope of practice. Additionally, NPPs employed in primary care and orthopedic practices accounted for 74% of all imaging interpreted by NPPs, with notable shares in subspecialty studies such as sinus CT in otolaryngology practices and spine MRI in orthopedic practices.

The findings underscore the need for further research into the adequacy of NPP training and its impact on diagnostic accuracy.

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