Why We Need Payment Reform, Reason # 17,847 (cardiac care edition)
This lede from the NY Times says it all:
Doctors who earn money for cardiac stress testing are much more likely to prescribe the tests than those who don’t, a new study has found.
The study, in the Journal of the AMA, looked at records for 17,847 patients nationwide who had coronary revascularization and a cardiac outpatient visit more than 90 days following the procedure. Their physicians were classified as billing for both the test and the professional fees (like supervision or interpretation), professional fees only, or not billing for either (on straight salary, for example). Logistic regression models were used to evaluate the association between physician billing and use of stress testing, after adjusting for patient age, disease characteristics and other physician factors.
The findings were dramatic. Doctors who were being paid for both the test and professional fees performed the nuclear stress test on 12.6% of patients. Those who were paid for just the professional fee ordered the test on 8.8% of their patients. And doctors who were not specifically paid for anything performed the test on 5.0% of patients. For stress echocardiography, same thing. Among physicians who billed for the test and professional fees, professional fees only, or neither, the cumulative incidence of testing was 2.8%, 1.4%, and 0.4% respectively.
How much would Massachusetts save if physicians were not paid on a fee for service basis? Based on this study, the costs of these cardiac tests might decline by more than half. That's why we need payment reform.