Doctors who receive reimbursements for technical and professional fees are 50% to 100% more likely to routinely order cardiac stress tests in discretionary situations compared to the ones who do not bill for the procedures or are only reimbursed for professional fees, researchers from Duke University Medical Center reported in JAMA (Journal of the American Medical Association)

Lead author, Bimal Shah, MD., said:

“The use of cardiac imaging technology has grown rapidly in this country and there is a lot of variation among physicians in terms of when and why they are used.

For the first time, we show that financial reimbursement structures may be yet another factor associated with this variation in testing behavior.”

Shah and team set out to determine how frequent the following types of cardiac stress imaging tests were ordered:

  • Nuclear tests – radioactive material is used to track blood flow
  • Echocardiography – uses ultrasound images.

They wanted to find out how many patients after undergoing PCI (percutaneous coronary intervention) and CABG (coronary artery bypass grafting) had routine stress testing.

According to the American College of Cardiology (ACC), no early stress testing should be ordered after these procedures unless there are certain symptoms or a cardiac event.

They found that several patients had to undergo these tests, despite the ACC guidelines. If the physician billed for interpreting or performing such tests the rate increased by nearly 100%.

Senior author, Eric Peterson, MD., said that routine stress testing can be problematic, because:

“It can expose the patients to unneeded radiation, and lead to more invasive downstream testing even when the testing likely doesn’t improve patient outcomes.This study is an important first step.”

Peterson added:

“. . . . we need more detailed clinical data to really determine why the tests were ordered. Thus, more study is needed.”

Shah said:

“Given that our medical system is already financially constrained, we need to be sure that our tests are for appropriate indications and not influenced by reimbursement structures.”

Written by Christian Nordqvist