Repeat Imaging Rates for Office-Based Imaging Studies Interpreted by Nonphysician Practitioners Compared With Radiologists.

Abstract

Purpose: As differences in imaging patterns may indicate unnecessary care, this study examined differences in repeat imaging rates between imaging studies interpreted by a nonphysician practitioner (NPP) versus a radiologist.

Methods: This multiyear (2013-2022) retrospective study evaluated imaging performed on Medicare fee-for-service beneficiaries using a CMS Research Identifiable File. Imaging studies, grouped by anatomic region and modality (eg, shoulder radiography [XR]) with ≥30 repeat studies within 90 days for both NPP-interpreted and radiologist-interpreted index studies, were included. Logistic regression was used to assess the likelihood of repeat imaging within 90 days for NPP-interpreted versus radiologist-interpreted index studies, adjusted for patient gender, age, race or ethnicity, comorbidities, urbanicity, and community income.

Results: There were 1,397,002 imaging studies that met the selection criteria. Of these, repeat imaging occurred for 12.5%. Unadjusted repeat imaging rates were higher for NPP-interpreted versus radiologist-interpreted imaging for XR (20.4% versus 14.6%), ultrasound (11.6% versus 4.5%), and MR (8.8% versus 3.8%). Adjusted for covariates, the odds ratio (OR) for repeat imaging was higher for NPP-interpreted versus radiologist-interpreted imaging: 1.35 (95% confidence interval [CI]: 1.33-1.37) for XR, 2.41 (95% CI: 2.21-2.63) for ultrasound, and 2.56 (95% CI: 1.81-3.64) for MR. By anatomic region-modality, these ORs ranged from 1.39 (95% CI: 1.34-1.44) for shoulder XR to 3.40 (95% CI: 2.80-4.14) for abdominal ultrasound, but was not significantly different for knee XR (OR: 1.01, 95% CI: 0.99-1.04).

Conclusion: Among Medicare beneficiaries, imaging studies are more likely to be repeated when interpreted by a NPP than when interpreted by a radiologist. Potential excess reimaging has implications for unnecessary care.