Duszak Richard, Walls D Gail, Wang Jennifer M, Hemingway Jennifer, Hughes Danny R, Small William C, Bowen Michael A
Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; College of Nursing, University of South Alabama, Mobile, Alabama.
J Am Coll Radiol. 2015 Mar;12(3):284-9. doi: 10.1016/j.jacr.2014.08.021. Epub 2014 Oct 16.
To evaluate national trends in nonvascular invasive radiology procedures performed by advanced practice providers (APPs), focusing specifically on nurse practitioners and physician assistants.
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.
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.
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.
评估由高级执业提供者（APPs）进行的非血管介入放射学程序的全国趋势，特别关注执业护士和医师助理。
我们在两家最大的医院中，以APPs常见的非血管介入放射学程序来确定用于全国趋势分析的程序组。我们每年将服务类别映射到1994年至2012年当时的现行程序编码，并使用医师供应商程序汇总主文件确定国家医疗保险B部分受益人的付费索赔频率。研究了APPs、放射科医生以及全国所有提供者在7类服务方面的趋势：腹腔穿刺术、胸腔穿刺术、细针穿刺抽吸（FNA）、浅表淋巴结活检、腹部活检、胸部活检和腹腔引流。
在截至2013年8月的1年时间里，我们机构的APPs共进行了1352例非血管介入程序，其中1161例（85.9%）属于这7个定义的类别。1994年至2012年期间，APPs的全国医疗保险索赔在所有这些类别中都大幅增加：腹腔穿刺术从0例增至17967例；胸腔穿刺术从119例增至4141例（增长3379%）；FNA从0例增至3921例；浅表淋巴结活检从0例增至251例；腹部活检从1例增至1819例（增长1818%）；胸部活检从0例增至552例；腹腔引流从37例增至410例（增长1008%）。总体而言，放射科医生和所有提供者的工作量都有所增加，APPs提供的全国服务总比例在腹腔穿刺术中从0%增至10.7%，在胸腔穿刺术中从0.1%增至5.7%，在FNA中从0%增至2.1%，在浅表淋巴结活检中从0%增至1.4%，在腹部活检中从0%增至1.7%，在胸部活检中从0%增至1.0%，在腹腔引流中从0.1%增至1.2%。
尽管在全国范围内，APPs进行的常见非血管介入放射学程序所占比例相对较小，但近20年来这些服务的医疗保险付费索赔大幅增加，且增速快于所有提供者的整体增速。鉴于获得医疗保险报销存在诸多障碍，这种增长表明在机构资质认证、州执照颁发和支付方政策层面，APPs作为程序服务提供者越来越被接受。
