Post-Revascularization Stress Testing Billing Ups Its Use

Billing for technical, professional testing fees, or both, ups stress testing usage

TUESDAY, Nov. 8 (HealthDay News) -- Doctors who bill for stress testing after coronary revascularization perform the testing more often than those who do not bill, according to a study published in the Nov. 9 issue of the Journal of the American Medical Association.

Bimal R. Shah, M.D., from Duke University Medical Center in Durham, N.C., and colleagues analyzed the relationship between physician billing and nuclear stress and stress echocardiography testing after coronary revascularization, with adjustments made for patient- and doctor-related factors. A cohort of 17,847 patients who had undergone coronary revascularization between 2004 and 2007 were seen for an index cardiac outpatient appointment more than 90 days later. Doctors were classified as billing for technical and professional fees, professional fees only, or neither service.

The investigators found that there was a 12.2 percent overall cumulative incidence of nuclear or echocardiography stress testing within 30 days of the index appointment. For doctors who billed for both technical and professional services, only professional services, or neither, the cumulative nuclear stress testing incidence was 12.6, 8.8, and 5.0 percent, respectively. Cumulative incidence for stress echocardiography was 2.8, 1.4, and 0.4 percent, respectively. Compared to patients treated by doctors who did not bill for testing, those treated by doctors who billed for both services and for only professional services had significantly increased adjusted odds ratios (aORs) of undergoing nuclear stress testing of 2.3 and 1.6, respectively. Corresponding aORs for patients undergoing stress echocardiography were significantly increased, at 12.8 and 7.1, respectively.

"Nuclear stress testing and stress echocardiography testing following revascularization were more frequent among patients treated by physicians who billed for technical fees, professional fees, or both," the authors write.

Two authors disclosed financial relationships with health insurance companies, including United Healthcare, which funded the study. Two authors disclosed financial ties to the pharmaceutical industry.

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