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.
Researchers at Duke
University studied data on 17,847 patients nationwide who had cardiac bypass
surgery or
coronary angioplasty, checking to see how often doctors prescribed
nuclear stress tests and echocardiograms later than 90 days after discharge.
Their results appeared Wednesday in The
Journal of the American Medical Association.
Among doctors who billed for administering and interpreting a stress test, 12.6
percent prescribed the test, compared with 5 percent of those who were not paid
for testing. Results for echocardiograms were similar: 2.8 percent of patients
were tested by doctors who billed for both test and interpretation, and 0.4
percent by those who were paid for neither.
After controlling for the patient’s age and disease characteristics, the
doctor’s specialty and other factors, researchers found that a patient of a
doctor earning money from testing was more than twice as likely to be tested as
a patient of a doctor without financial interest in the tests.
“If
you’re having symptoms or a change in health status, testing is appropriate,”
said Dr. Bimal R. Shah, the lead author of the analysis and a fellow in
cardiology at Duke. “But in situations where there aren’t any clinical
indications for tests, these reimbursement structures seem to be associated with
increased testing use.”