Doctors who own and bill for nuclear cardiac stress-test technology are twice as likely to order the procedure as those who aren’t paid for it, researchers said.
The widest variation in whether a doctor prescribed a nuclear stress test, which uses radiation to track blood flow, occurred when patients had no symptoms of coronary disease following bypass surgery or other heart procedures, according to a study published Tuesday in the Journal of the American Medical Association. Physicians who owned the equipment ordered tests in 10 percent of the cases versus 4.3 percent for those who didn’t.
Spending on medical technology has been cited as a contributor to making the U.S. health system the most expensive in the world, said Bimal Shah, the lead author of the report. The study is the first to examine whether physician billing adds to the volume of stress testing and demonstrated that reimbursement appeared to push up the numbers, he said.
“When physicians had the discretion because patients were asymptomatic, reimbursement made the doctors more likely to order the tests,” Shah, a cardiologist at the Duke University Medical Center in Durham, North Carolina, said in a telephone interview. “There’s an expanding role for this kind of imaging and our findings would lead us to conclude that the need to recoup an investment in the equipment could be a factor in that growth.”
The American College of Cardiology recommends no early stress testing after these procedures if a patient has no symptoms. It issued this guideline in 2007.
17,847 Patients
The study reviewed billings for 17,847 UnitedHealth Group Inc. plan members from 2004 to 2007. The researchers found that 14 percent of the patients who had stress tests more than 90 days after cardiac procedures were experiencing chest pain, angina, or shortness of breath; 86 percent didn’t have symptoms based on the information supplied to the insurance company.
