Section spotlight By Kathy Taylor, MS, FNP-BC


The advantages of nurse practitioners and physician assistants in IR


The author thanks Chris Davis, PA-C RT, and Anne Marie McLellan, DO, for their assistance with this article.


Overview Over the last 20 years, IR has seen an increase in the hiring of advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs). IRs are recognizing such benefits as increasing revenue, throughput, billing and interface of APPs with providers/patients. APPs often become the face of IR in the facility. They increase the turnaround times in the IR suite. APPs become an integral part of the IR team.


While the physician is in difficult or complex procedures, the APP can deal with minor procedures such as thoracentesis, paracentesis, ports, dialysis catheters and nephrostomy tube changes, among others. APPs can also round on inpatients, consults and follow-ups.


They write pre- and post-op orders and can put out fires, deal with phone calls and intercept complications. More than 90 percent of these procedures are billable, and there are evaluation and management (E&M) codes for phone calls.


One disadvantage is that APPs can bill at only 85 percent of what the physician bills, but that lower level is offset by the increased volume of completed procedures. That is revenue generated that might otherwise have been pushed to a later date or after hours.


There is not much difference in the function of an NP and a PA. Whether or not an APP performs procedures is a matter of their personal preference, not determined by specific profession. Their main difference is in education.


36 IRQ | WINTER 2019


APP education PA training PAs must first have earned a bachelor’s degree in any academic area. Next they must attend PA school, where they are trained in the medical model—undergoing 24–27 months of both didactic and clinical training, including medical sciences, anatomy, pathophysiology and coursework in medical specialties.


Clinical training for PAs involves rotations with physicians and PA preceptors in core medical disciplines such as family medicine, emergency medicine, internal medicine, women’s health, pediatrics, surgical specialties and behavioral health. PA students see patients in collaboration with their preceptor, conduct histories and physicals, order diagnostic studies, and develop a diagnosis. Clinical training results in more than 2,000 hours of direct patient care.


At the completion of their training program, PA students are awarded their Master of Science and are eligible to take the Physician Assistant National Certifying Exam (PANCE).


NP training An NP’s four-year undergraduate education as a registered nurse (RN) results in a Bachelor of Science degree; prerequisites include a year of anatomy and physiology as well as chemistry and biochemistry. RNs are educated using the nursing model: assessing the patient, planning the needed care, implementing that care and evaluating the results of that plan. Nursing theory centers on the patient, the environment, health and nursing (goals, roles and functions).


Note: PAs and PAs are considered APPs. The term “midlevel” is no longer used.


Approximately 500 clinical hours are required in the areas of obstetrics, adult health, pediatrics, psychiatry and community health. The graduate nurse usually works as an RN for a minimum of two years.


The RN then goes on to obtain an advanced degree to become an NP. This requires a minimum of 1,000 hours of clinical along with didactic courses. The degree earned is either a Master of Science in Nursing or a Doctorate of Nursing Practice.


Scope of practice As already noted, there is not much difference in the function of an NP and a PA—i.e., an NP can do all the things a PA does.


PAs work with a supervising physician providing health care for patients. PAs work in all specialties of medicine, including radiology. PAs bill under their own NPI number and can see their own panel of patients. Supervisory regulations differ from state to state, however in general delegation authority is left to the decision of the individual practice. PAs have prescriptive authority in all 50 states. Procedures performed by PAs vary from practice to practice, depending on the local hospital environment. These can range from lumbar puncture to image guided biopsies to DVT thrombolysis. In addition to procedures, PAs provide consultations, round on pre and post procedure patients, and communicate with referring physicians. PA practice at the local level can evolve over time with additional training and experience of the individual PA.


Most states require the NP to be nationally certified. The advanced clinical training allows the NP to diagnose illnesses, perform physical


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