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Screening: Doctors Paid for Heart Tests Order More

By NICHOLAS BAKALAR
Published: November 14, 2011

Doctors who earn money for cardiac stress testing are much more likely to prescribe the tests than those who donít, a new study has found.

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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 patientís age and disease characteristics, the doctorís 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.

ďIf youíre having symptoms or a change in health status, testing is appropriate,Ē said Dr. Bimal R. Shah, the lead author of the analysis and a fellow in cardiology at Duke. ďBut in situations where there arenít any clinical indications for tests, these reimbursement structures seem to be associated with increased testing use.Ē