Large rise in Medicare claims for noninvasive testing
MedWire News: Noninvasive testing accounted for a major proportion of the increase in cardiology services provided to Medicare beneficiaries from 1999 to 2008, US researchers say.
Although there was rapid growth of new imaging techniques such as cardiac computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), resting echocardiography and nuclear stress testing were the most often used, report Bruce Andrus and Gilbert Welch (Dartmouth Medical School, Hanover, New Hampshire, USA).
They analyzed fee-for-service Medicare Part B claims for each year from 1999 to 2008 and selected claims from physicians whose specialty code was cardiology (CPT-9). They then grouped 100 CPT-9 codes into 45 specific service groups that were further aggregated into three broad service categories: evaluation and management, noninvasive procedures, and invasive procedures.
The sample size ranged from 30.9 million beneficiaries in 1999 to 31.7 million in 2008. During the 10-year period, the number of claims from cardiologists increased by 44%, from 2082 to 2997 per 1000 beneficiaries.
After adjusting for inflation, the allowed charges over this period increased by 28%, from US$ 181,397 (€ 143,167) to US$ 231,728 (€ 182,894) per 1000 beneficiaries.
The rate of noninvasive procedures increased much faster over this period, at 70%, than did that of invasive procedures, at 25%, or management services, at 18%.
Noninvasive procedures accounted for 78% of the total increase in services, compared with 5% for invasive procedures and 15% for evaluation and management.
Although the rate of noninvasive imaging technologies cardiac CT, MRI, and PET all increased sixfold, nuclear stress testing and resting echocardiography accounted for the majority of the overall growth in services, at 32% and 16% respectively, and the majority of growth in charges, at 27% and 18%, respectively.
The researchers suggest a number of possible explanations for this growth in noninvasive imaging, including patient demand, waning confidence in physical examination skills, and new indications for devices such as defibrillators and cardiac resynchronization therapy that are based on ejection fraction.
They caution that "increasing utilization of nuclear stress testing and echocardiography strains the sustainability of Medicare and drives declining reimbursement for these studies."
Andrus and Welch conclude in Circulation: Cardiovascular Quality and Outcomes: "We applaud the development of appropriate use criteria by the cardiology community and support its continued evidence-based development and integration with electronic medical record systems as an alternative to simply reducing reimbursement across the board."
MedWire (http://www.medwire-news.md/) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Piriya Mahendra