Low-Value Back Imaging in the Care of Medicare Beneficiaries: A Comparison of Nurse Practitioners and Physician Assistants. (June 2021)

• Record Type: Journal Article
• Authors: O'Reilly-Jacob, Monica; Perloff, Jennifer; Buerhaus, Peter
• Is Part Of: Medical care research and review. Volume 78:Number 3(2021)
• Page Start: 197
• Page End: 207
• Publication Date: 2021-06
• Subjects: nurse practitioner -- physician assistant -- low-value -- imaging -- Medicare; Medical care -- United States -- Periodicals; Medical care -- Periodicals; Medical care -- Research -- United States -- Periodicals; Medical care -- Research -- Periodicals; Medical economics -- United States -- Periodicals; Medical economics -- Periodicals; 362.10973
• DOI: 10.1177/1077558719877796
• Languages: English
• ISSNs: 1077-5587

Abstract

Little is known about practice pattern differences between nurse practitioners (NPs) and physician assistants (PAs). We compared the rates of low-value back images ordered by NPs and PAs. For this comparison, we used 2012-2013 Medicare Part B claims for all beneficiaries in 18 hospital referral regions and a measure of low-value back imaging from the Choosing Wisely recommendations. Models included a random clinician effect and fixed effects for beneficiary age, disability, Elixhauser comorbidities, clinician type, the emergency department setting, and region. NPs ( N = 234) order low-value back images significantly less than PAs ( N = 204) (NPs 25.5% vs. PAs 39.2%, p < .0001). Controlling for relevant factors, NPs are 10.0 percentage points ( p < .0001) less likely to order a low-value back image than PAs. NPs and PAs have distinct patterns of low-value back imaging, which is likely a reflection of their different practice settings.