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

Abstract

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. 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. 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). 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.