Day of Week, Site of Service, and Patient Complexity Differences in Venous Ultrasound Interpreted by Radiologists Versus Nonradiologists

Abstract

Objective: Nationally, nonradiologists interpret an increasing proportion of lower extremity venous duplex ultrasound (LEVDU) examinations. We aimed to study day of week, site of service, and patient complexity differences in LEVDU services interpreted by radiologists versus nonradiologists.

Materials and methods: Using carrier claims files for a 5% national sample of Medicare beneficiaries from 2012 to 2015, we retrospectively classified all LEVDU examinations by physician specialty (radiologist versus nonradiologist), day of week (weekday versus weekend), site of service, and patient Charlson Comorbidity Index (CCI) scores. Pearson's χ² was used to test statistical significance.

Results: Of 760,433 LEVDU examinations for which provider specialty could be determined, 439,964 (58%) were interpreted by radiologists and 320,469 (42%) by nonradiologists. On weekends, radiologists interpreted 75% (66,094 of 88,244) and nonradiologists 25% (22,150 of 88,244) (P < .0001). Of LEVDU examinations interpreted by radiologists, 57% were performed in the inpatient or emergency department settings, and 70% of LEVDU examinations interpreted by nonradiologists were performed in the private office or outpatient hospital setting. Radiologists interpreted a slightly larger proportion (17%) of their examinations on patients with more comorbidities (CCI of ≥3) than nonradiologists (15%) (P < .0001).

Conclusion: Compared with nonradiologists, radiologists interpret a disproportionately larger share of weekend (versus weekday) LEVDU examinations and a considerably larger proportion in higher acuity settings. Additionally, the patients on whom they render services have more comorbidities. To optimize around-the-clock patient access to necessary imaging, emerging quality payment programs should consider the timing and sites of service, as well as patient complexity.

Keywords: Ultrasound; nonradiologist; patient complexity; site of service; venous; weekend.