{"id":13157,"date":"2011-11-08T18:37:08","date_gmt":"2011-11-08T23:37:08","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=13157"},"modified":"2011-11-08T18:37:08","modified_gmt":"2011-11-08T23:37:08","slug":"financial-incentives-increase-use-of-stress-tests","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/11\/08\/financial-incentives-increase-use-of-stress-tests\/","title":{"rendered":"Financial Incentives Increase Use of Stress Tests"},"content":{"rendered":"<p>Following coronary revascularization, patients are more likely to undergo cardiac stress testing if their physician has a financial interest in the test, according to a <a href=\"http:\/\/jama.ama-assn.org\/content\/306\/18\/1993.abstract\">new study published in\u00a0<em>JAMA<\/em><\/a>.<\/p>\n<p>Bimal Shah and colleagues examined insurance data from 17,847 patients who underwent revascularization, dividing their physicians into three groups: those who billed for technical and professional fees, those who billed for professional fees only, and those who billed for neither.<\/p>\n<p>The overall rate of nuclear or echo stress testing within 30 days was 12.2%, but there was a large difference in the testing rate across the three groups:<\/p>\n<p>Nuclear stress testing:<\/p>\n<ul>\n<li>12.6% for physicians who billed for both technical and professional fees<\/li>\n<li>8.8% for those who billed for professional fees only<\/li>\n<li>5.0% for those who billed for neither<\/li>\n<\/ul>\n<p>Stress echocardiography:<\/p>\n<ul>\n<li>2.8%\u00a0for physicians who billed for both technical and professional fees<\/li>\n<li>1.4%\u00a0for those who billed for professional fees only<\/li>\n<li>0.4%\u00a0for those who billed for neither<\/li>\n<\/ul>\n<p>The authors found that &#8220;up to 1 in 10 patients who were not coded as having symptoms at their outpatient visit still underwent stress testing.&#8221; They note that current guidelines &#8220;do not recommend routine use of early stress testing following coronary revascularization,&#8221;\u00a0 and they conclude that their results &#8220;suggest the need for broader application of AUC [appropriate use criteria] to minimize the possible influence of financial incentives on the decision to perform cardiac stress testing after revascularization.&#8221;<\/p>\n<p>In <a href=\"http:\/\/jama.ama-assn.org\/content\/306\/18\/2028.extract\">an accompanying editoria<\/a>l, Brent Hollenbeck and Brahmajee Nallamothu place the study in the context of new trends in reimbursement from CMS and the large structural shift in cardiology toward hospital-based practices. They point out that &#8220;controversies surrounding physician self-referral and associated incentives wax and wane, and are seemingly repeated each decade.&#8221; As an alternative, they suggest that &#8220;the focus should be less about eliminating incentives altogether, and more about getting the price right in the first place.&#8221;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Following coronary revascularization, patients are more likely to undergo cardiac stress testing if their physician has a financial interest in the test, according to a new study published in\u00a0JAMA. Bimal Shah and colleagues examined insurance data from 17,847 patients who underwent revascularization, dividing their physicians into three groups: those who billed for technical and professional [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,13,1,9],"tags":[1034,1033,227,497],"class_list":["post-13157","post","type-post","status-publish","format-standard","hentry","category-cardiac-imaging","category-electrophysiology","category-general","category-interventional-cardiology","tag-financial-incentives","tag-nuclear-stress-test","tag-stress-echocardiography","tag-stress-tests"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/13157","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=13157"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/13157\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=13157"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=13157"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=13157"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}