Financial Factors Can Influence Cardiac Stress Testing Decisions
Fri, November 25, 2011 at 03:00AM I’m sorry to be reporting this, but it seems that some physicians are more mercenary than conscientious. This is the conclusion of a report from Duke University Medical Center, published in the Journal of the American Medical Association. The researchers wanted to see if there was an association between physician billing and cardiac stress testing following coronary artery revascularization procedures, such as stent placement or bypass surgery. According to the American College of Cardiology (ACC), no early stress testing should be ordered after these procedures unless there are certain symptoms of a cardiac event – e.g. a heart attack or severe angina.
The Duke team examined the frequency of two types of cardiac stress imaging tests – nuclear tests, and echocardiography. They used data from a national health insurance carrier on 17,500 patients who had a revascularization procedure with a cardiac outpatient visit more than 90 days after the procedure. Billing data showed whether the physician billed for both technical (practice/equipment) and professional (interpretation of results) fees, professional fees only, or not billing for either.
The rates for nuclear stress testing were 12.6%, 8.8%, and 5.0% for physicians billing for technical plus professional fees, professional fees only, or neither, respectively. For stress echocardiography the rates were 2.8%, 1.4%, and 0.4% for the same three categories, respectively. These figures speak for themselves. It seems clear that differences in reimbursements influenced the physicians’ decisions about the need for these stress testing.
This is an unsatisfactory situation. Unnecessary ordering of tests costs the health system and the patient more, and exposes the patient to unneeded radiation. Patients can, perhaps, improve the situation by a simple question: “Is this test really necessary, doctor?” This may be sufficient to induce the physician to ensure his orders fall within the ACC guideline.
Reader Comments (1)
Really something to ponder over. Financial factors can be a major reasons for it.