Self-Interpretation of Imaging Studies by Ordering Providers: Frequency and Associated Provider and Practice...

BACKGROUND. Imaging self-interpretation refers to interpretation of an imaging study by the study's ordering provider. This phenomenon warrants scrutiny given non-radiologists' limited training in imaging interpretation. OBJECTIVE. The purpose of the study was to evaluate the frequency of self-interpretation of office-based diagnostic imaging by ordering providers and assess associations of ordering provider and practice characteristics with self-interpretation, with-in-practice interpretation, and radiologist interpretation. METHODS. This retrospective study used the CMS 5% Research Identifiable File for calendar year 2022 to identify claims for office-based nonbreast diagnostic imaging ordered by nonradiologists for a nationally representative sample of Medicare fee-for-service beneficiaries. Ordering provider and practice characteristics were extracted from the Medicare Data on Provider Practice and Specialty dataset. Self-interpretation, within-practice interpretation, and radiologist interpretation were summarized. Logistic regression models were used to assess associations with self-interpretation and within-practice interpretation for six selected combinations of ordering provider specialty and modality with high imaging volumes. RESULTS. The study included 1,632,212 imaging claims. The unadjusted self-interpretation, within-practice, and radiologist interpretation rates overall were 43.6%, 58.5%, and 36.4%, respectively. The unadjusted self-interpretation rate was 50.4% for radiography and fluoroscopy, 52.0% for ultrasound, 5.2% for CT, 6.1% for MRI, and 39.5% for nuclear medicine. The adjusted odds of self-interpretation were lower for providers with versus without a within-practice radiologist for five of six selected specialty-modality combinations (lowest odds for nonphysician practitioner-ordered radiography and fluoroscopy: OR = 0.44) and lower for providers in the largest versus the smallest practices for all selected combinations (lowest odds for orthopedic surgery and sports medicine [orthopedic/sports]-ordered MRI: OR = 0.01). The adjusted odds of with-in-practice interpretation were higher for providers in practices with versus without a within-practice radiologist for five of six selected combinations (highest odds for orthopedic/sports physician-ordered MRI: OR = 8.15). Across practice sizes, the unadjusted rate of radiologist interpretation for radiography and fluoroscopy ranged from 15.5% to 36.2% and from 24.9% to 61.1% for ordering providers in practices with versus without a within-practice radiologist, respectively. CONCLUSION. Self-interpretation by nonradiologist ordering providers occurred for 43.6% of office-based imaging studies and, in general, was less likely for large practices or practices with a within-practice radiologist. CLINICAL IMPACT. Ongoing health care consolidation may partially address the current high rate of imaging self-interpretation by potentially allowing access to a with-in-practice radiologist.