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 today 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 today’s 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.
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.
In recent years, there has been a shift from testing in hospitals toward physician offices as more practices invest in the imaging technology, the study said. The findings emphasize the need for broader adoption of the cardiology association’s guidelines and then it takes “years, and even decades” for such evidence to be disseminated, Shah said.
The average retail price of a nuclear camera is about $225,000, according to the Orlando Medical News in Orlando, Florida, and other medical equipment publications. For each procedure, a doctor may be paid about $1,000, according to Florida cardiologists surveyed by the journal.
“We have to remember that unnecessary testing puts patients at unnecessary risk of exposure to radiation and also finding false positives that lead to even more medical care,” said Shah, an assistant professor at Duke’s medical school who also holds a master’s of business administration from the university.
Shah and his colleagues also looked at the use of ultrasound images used in echocardiography. With this technology, which is used less frequently, doctors owning the equipment performed the tests six times more often, ordering it for 2.5 percent of the patients without symptoms compared with 0.4 percent for doctors not billing for the test.