Comparing the rates of low-value back images ordered by physicians and nurse practitioners for Medicare beneficiaries in primary care Monica O’Reilly-Jacob, RN, PhD, FNP-BC* ,a , Jennifer Perloff, PhD b , Peter Buerhaus, RN, PhD, FAAN, FAANP(h) c a Boston College, William F. Connell School of Nursing, Chestnut Hill, MA b Brandeis University, The Heller School for Social Policy and Management, Waltham, MA c Montana State University, Center for Interdisciplinary Health Workforce Studies, Bozeman, MT ABSTRACT Background: Little is known about the extent of ordering low-value services by. Purpose: To compare the rates of low-value back images ordered by primary care physicians (PCMDs) and primary care nurse practitioners (PCNPs). Method: We used 2012 and 2013 Medicare Part B claims for all beneficiaries in 18 hospital referral ̱ regions (HRRs) and a measure of low-value back imaging from Choosing Wisely. Models included random clinician effect and fixed effects for beneficiary age, disability, Elixhauser comorbidities, clinician sex, the emergency department setting, back pain visit volume, organization, and region (HRR). Findings: PCNPs (N = 231) and PCMDs (N = 4,779) order low-value back images at similar rates (NP: all images: 26.5%; MRI/CT: 8.4%; MD: all images: 24.5%; MRI/CT: 7.7%), with no detectable significant difference when controlling for covariates. Discussion: PCNPs and PCMDs order low-value back images at an effectively simi- lar rate. Cite this article: O’Reilly-Jacob, M., Perloff, J., & Buerhaus, P. (2019, xxx). Comparing the rates of low-value back images ordered by physicians and nurse practitioners for Medicare beneficiaries in primary care. Nurs Outlook, 00(00), 112. https://doi.org/10.1016/j.outlook.2019.05.005. ARTICLE INFO Article history: Received 3 January 2019 Received in revised form 24 April 2019 Accepted 15 May 2019 Keywords: Nurse practitioner Low-value Imaging Back pain Medicare Introduction As much as 30% of health care spending in the United States is attributed to the provision of unnecessary services and systematic inefficiencies (Berwick & Hackbarth, 2012; Institute of Medicine, 2012). A sub- stantial portion of this spending, which some label as wasteful, is on low-value care (Colla, Morden, Sequist, Schpero, & Rosenthal, 2015; Schwartz, Landon, Elshaug, Chernew, & McWilliams, 2014; Segal et al., 2014), defined as health care services that are mini- mally beneficial or involve a risk that outweighs any potential benefit (Institute of Medicine, 2001). The Medicare Payment Advisory Commission estimates that 37% of Medicare beneficiaries received at least one low-value service in 2012, costing Medicare $5.8 billion (Medicare Payment Advisory Commission, 2016). In recent years, the call to study and reduce low- value care has been increasing. For example, the * Corresponding author: Monica O’Reilly-Jacob, Boston College, William F. Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA 02467. E-mail address: monica.oreilly@bc.edu (M. O’Reilly-Jacob). 0029-6554/$ -see front matter Ó 2019 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.outlook.2019.05.005 ARTICLE IN PRESS Available online at www.sciencedirect.com Nurs Outlook 0 00 (2019) 1 12 www.nursingoutlook.org