Radiology Business has an online update on an alliance between the American Medical Association (AMA) and the (ACR) American College of Radiology that, according to an ACR release, is creating  "advocacy resources for physicians and patients that fight back against non-physician scope of practice expansion." This effort comes at a time when state legislatures and state health departments are considering new laws and regulations that could expand the scope practice of non-physician practitioners (NPPs), like nurse practitioners and physician assistants, as well as radiologist assistants and radiology practice assistants (RAs/RPAs). 

Resources directed at patients recommend that they "ask for a physician." And ACR has tracked almost 100 bills filed in state legislatures around the country to address state scope of practices for NPPs. I support that effort to block mid-levels from expanding their scope into areas that should be the exclusive domain of the radiologists, like interpreting radiological images.

But the big question for me is how much push back will come from ACR to some scope of practice expansion that could actually be beneficial to radiologists. I believe some strategic expansion or scope for these mid-levels in radiology is necessary in many states.

Radiologists, I contend, should support scope of practice expansion in states where the rules don't appear to allow NPPs and RAs/RPAs to perform in a manner now permitted under changes to Medicare supervision rules made in the last several years. My experience working with my radiologist clients leads me to believe they want to be able to make appropriate use of RAs/RPAs and NPPs in their practice.

These are the steps that I hope ACR and its state chapter leaders will embrace.

First, ACR should support the enactment of state RA/RPA licensure laws in those states without such laws. In 2019, CMS recognized that RAs and RPAs, who have higher levels of training, should be allowed to "perform" fluoroscopic-guided tests (Level 3 tests) even when a physician is not in the room, so long as the RAs and RPAs act within their scope of practice under state licensing laws to perform such fluoroscopic-guided tests. Even though the majority of states have enacted RA/RPA licensure laws and rules, not all states have defined such licensure for these practitioners. ACR would greatly benefit its members if it supported state RA/RPA scope of practice legislation to facilitate increased flexibility in the performance of these fluoroscopic-guided tests.

Second, ACR should support the expansion of state scope of practice laws for nurse practitioners (NPs) and physician assistants (PAs) to authorize NPs and PAs to supervise diagnostic tests when contrast is administered to enhance image quality. In 2021, CMS amended its diagnostic test supervision rules to permit NPPs to provide direct supervision for Level 2 tests (e.g., MRIs or CTs with contrast) that require the proximity of being in the office suite and immediately available, but not in the room where the test is administered. Prior to that change, Medicare rules permitted only fully-licensed physicians to provide that supervision. My radiology group and imaging center clients want the flexibility to utilize an NP or PA in their practice, but they are frustrated that many state laws do not permit precisely what Medicare now allows. 

I hope the College's leadership, as they fight inappropriate scope creep, will also see the wisdom of supporting a slightly expanded scope of practice for these mid-level practitioners at the state level. ACR and its state chapters have an opportunity to work with their state legislatures to give their members the flexibility to work with mid-level practitioners performing radiological diagnostic tests in the manner that Medicare now allows.