Physician fees influence testing after revascularization
MedWire News: Patients are more likely to undergo nuclear stress testing and stress echocardiography after revascularization if their physician bills for technical or professional fees or both, an analysis has found.
Appropriateness utilization criteria must be more broadly applied to minimize the influence of financial incentives on the decision to perform cardiac stress testing after revascularization, report Bimal Shah (Duke University Medical Center, Durham, North Carolina, USA) and co-authors.
They used a national health insurance carrier to identify 17,847 patients between 2004 and 2007 who attended an index cardiac outpatient visit more than 90 days after undergoing coronary revascularization.
After adjusting for patient and physician factors, the overall cumulative incidence of nuclear or echocardiography stress testing within 30 days of the index cardiac-related outpatient visit following revascularization was 12.2%.
The cumulative incidence of nuclear stress testing was 12.6%, 8.8%, and 5.0% among physicians who billed for both technical and professional fees, professional fees only, or neither, respectively.
Corresponding stress echocardiography rates were 2.8%, 1.4%, and 0.4%.
Patients treated by physicians who billed for technical and professional fees, or professional fees only were a significant 2.3 times and 1.6 times more likely, respectively, to undergo nuclear stress testing than those treated by physicians who did not bill for testing (p<0.001).
Furthermore, patients treated by physicians who billed for both or professional fees only were a significant 12.8 times and 7.1 times more likely to undergo stress echocardiography testing than those treated by physicians who did not bill for testing (p<0.001).
In a related commentary, editorialists Brent Hollenbeck and Brahmajee Nallamothu (University of Michigan, Ann Arbor, USA) write: "Regulation is imperfect - all of the nuances involved in the art of clinical care cannot be regulated.
"Although most physicians delivering patient care recognize the limits of regulation, perhaps it is time for policymakers to do so as well."
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By Piriya Mahendra