UPJ INSIGHT Changing Roles of Urologists, Radiologists, and Advanced Practice Providers in Uroradiology Procedures

By: Austin J. Lee, MD, University of Rochester Medical Center, New York; Timothy Campbell, MD, University of Rochester Medical Center, New York; Carl A. Ceraolo, MD, University of Rochester Medical Center, New York; Aaron Saxton, MD, University of Rochester Medical Center, New York; Scott O. Quarrier, MD, University of Rochester Medical Center, New York; Jathin Bandari, MD, University of Rochester Medical Center, New York | Posted on: 19 Jan 2024

Lee AJ, Campbell T, Ceraolo CA, Saxton A, Quarrier SO, Bandari J. The changing roles of urologists, radiologists, and advanced practice providers in uroradiology procedures. Urol Pract. 2024;11(1):228-235.

Study Need and Importance

Urology has seen shifts in the management of many urologic conditions with the advent of noninvasive procedures that rely on multidisciplinary radiological modalities. This study seeks to analyze changes in urologists, radiologists, and advanced practice providers (APPs) performing uroradiology procedures over time.

What We Found

There were significant changes in all examined uroradiology procedures when examining procedure Medicare reimbursement distribution between urologists, radiologists, and APPs in 2010 to 2021 (P < .001; Table). During the period, urology saw decreases in reimbursement proportion as large as 28.7% for kidney cryoablation and increases as large as 14.2% for nephrostomy tube removals. Radiology saw the largest decreases in reimbursement proportion with an 18.9% decrease for nephrostograms, while the largest increase was 23.6% for suprapubic tube placements. APPs saw the largest increase in suprapubic tube changes reimbursement proportion, which rose 14.2% from 2010 to 2021. There were also significant changes in proportion of Medicare procedure count in all uroradiology procedures, except for antegrade stent, renal cryoablation, renal biopsy, and renal thermoablation.

Table. Changes to Proportion of Medicare Reimbursement by Procedure and Specialty in 2021 vs 2010

Procedure	Urology	Radiology	APP	P value
Antegrade stent	2.9	−2.9	−0.1	< .001
Cryoablation	−28.7	29.0	−0.3	< .001
Nephrostogram	17.9	−18.9	0.9	< .001
PCN exchange	−6.3	5.6	0.7	< .001
PCN placement	0.3	−0.2	−0.1	< .001
PCN removal	14.2	−16.3	2.1	< .001
Prostate biopsy	−0.5	0.1	0.4	< .001
Renal biopsy	−1.2	0.8	0.4	< .001
Renal cyst aspiration	7.2	−8.9	1.7	< .001
SPT change	−14.9	0.7	14.2	< .001
SPT placement	−26.3	23.6	2.8	< .001
Thermoablation	−3.6	3.5	0.1	< .001
Transrectal ultrasound	1.0	−1.8	0.8	< .001
Abbreviations: APP, advanced practice provider; PCN, percutaneous nephrostomy; SPT, suprapubic tube.

Limitations

The data for the study only include Medicare beneficiaries and do not represent all uroradiology procedures. Additionally, these data do not provide the context in which APPs were involved with these procedures or their affiliated specialty. Lastly, the context of procedures cannot be extrapolated from the dataset.

Interpretation for Patient Care

The provider type that performs uroradiology procedures has seen shifts for each examined procedure. Most large changes in reimbursement and procedure proportion were shifted between urology and radiology, with APPs seeing smaller changes. Management of many urologic conditions for patients subsequently may be influenced by who performs each procedure, with potential differences in outcomes, complications, and follow-up management.