Applied Radiology: Scope of Practice Legislation Across the US: Current Trends in Evidence, Advocacy, and Action

February 29, 2024

Applied Radiology: Scope of Practice Legislation Across the US: Current Trends in Evidence, Advocacy, and Action

Scope of practice (SoP) for nonphysician providers (NPPs) has long been the subject of controversy in the medical community. This includes radiology, as evidenced by the attention focused on the topic at the 2023 Centennial Meeting of the American College of Radiology (ACR).

An understanding of the issues and legislative challenges surrounding SoP is relevant to practicing radiologists and radiologists-in-training. This article aims to provide a foundational review of legislative challenges, relevant research, and other important considerations pertinent to SoP as it relates to radiology.

COVID-19 Puts a Spotlight on Scope of Practice

The severity and breadth of the COVID-19 pandemic created a sustained requirement for more care than could be achieved by the existing physician workforce. The responsibilities of many physicians moved beyond their areas of specialization to help address the needs of the most severely ill patients.

These extraordinary circumstances left many physician duties uncovered or put on pause; as a result, many NPPs assumed some of these responsibilities, in effect expanding their scope of practice, albeit temporarily.

But as the pandemic receded and most physicians returned to their “normal” practice, debate around permanent practice in- dependence for advanced practice registered nurses (APRNs), physician assistants (PAs), and other NPPs gained momentum. For NPPs, the temporary adaptations to the global pandemic added fuel to their drive for greater practice autonomy, and legislative proposals for full practice authority increased.

According to the US Department of Health and Human Services, “nurse practitioners (NPs), clinical nurse specialists, and PAs are health care providers who practice either in collaboration with or under the supervision of a physician” and designates them as NPPs.1

The Balanced Budget Act of 1997 expanded reimbursement for NPP services from rural areas to all geographic and healthcare settings. As a result, nurse practitioners and clinical nurse specialists are allowed to bill Medicare directly, while PAs must continue to be billed by an employer.

With respect to education, PAs train in an accelerated format based on the traditional medical school curriculum. In contrast, APRNs receive a bachelor of science in nursing and a master’s or doctorate degree in nursing practice in addition to specific clinical licensure in an area of practice such as anesthesia (eg, certified registered nurse anesthetist). These curricula focus on care delivery and patient-centered management as opposed to the basic and clinical science coursework covered in the medical school model.

The ACR defines non-physician radiology providers (NPRPs), which includes NPPs, and registered radiology assistants (RAs), and develops policies and guidelines regarding their scope of practice.2 Radiology assistants are critical to many imaging practices and, by definition, work under the supervision of radiologists.3 The two professions have historically worked hand-in-hand; it’s worth noting that RAs are not seeking scope expansion.4

In the first half of 2023, the ACR identified 41 bills in 21 states related to increasing scope or full practice authority for PAs and 40 bills in 18 states for APRNs. Bills expanding SoP for PAs have been passed in four states: Arkansas, Arizona, Colorado, and Montana. To date, 26 states and the District of Columbia have assigned full practice authority rights to APRNs.

Legislative proposals addressing radiology, meanwhile, range from allowing NPRPs to order radiologic examinations to certifying PAs in fluoroscopy with 40 hours each of didactic and clinical training.

In addition, some state legislative proposals go beyond SoP issues to focus on shifting their entire oversight structure of radiology. In Tennessee, for example, SB 1191 and HB 1388 would eliminate the state Radiologic Imaging and Radiation Therapy Board of Ex- aminers. In its place, the Tennessee Department of Health Division of Health-Related Boards would license all persons performing radiologic imaging, radiography, or radiation therapy procedures in any healthcare setting.

READ MORE: https://appliedradiology.com/Articles/scope-of-practice-legislation-across-the-us-current-trends-in-evidence-advocacy-and-action#

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