Comparing the rates of low-value back images ordered by physicians and nurse practitioners for Medicare beneficiaries in primary care

•In the treatment of low back pain in primary care, nurse practitioners and physicians order low-value imaging at the same rate.•Both individual clinicians and organizations play important roles in the prevalence of low-value imaging.•Continued collaborative programs at the clinician and organization levels are needed to reduce the use of unnecessary services.•Medicare could improve their data by identifying claims that are billed incident-to, delineating nurse practitioner specialty codes and ensure referring clinicians are identifiable on all diagnostic services. Little is known about the extent of ordering low-value services by. To compare the rates of low-value back images ordered by primary care physicians (PCMDs) and primary care nurse practitioners (PCNPs). 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). 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. PCNPs and PCMDs order low-value back images at an effectively similar rate.