Heart Scans Costing $2,000 Each Unneeded In One Of Five Cases
Almost one-quarter of the unneeded tests were ordered by doctors who werent heart specialists, according to research reported today at the American College of Cardiology meeting in Orlando, Florida. Some heart doctors may give the test to assure “worried well” patients, even if they dont have sufficient symptoms to warrant a scan, said Michael Crawford, chief of cardiology at the University of California at San Francisco.
“The consumer asks a cardiologist, Am I going to drop dead?” said Crawford, who was not involved in the study, in a telephone interview. “You think: Probably not. But gee, if the person drops dead, is the family going to sue me?”
The research, supported by both insurer and cardiologist groups, reviewed 3,035 so-called nuclear heart scans involving 6,351 patients. It found that 66 percent were appropriate. Another 18 percent werent needed and 16 percent were ambiguous. The tests, which measures blood flow at rest and during exercise to identify possible blockages, are the second largest expense for Unitedhealth Group Inc. after office visits, said Chad Peel, vice president of cardiology services at the insurers United Healthcare unit, in a telephone interview.
Reining in runaway imaging tests could save $260 million to help fund health-care reform, U.S. President Barack Obama said in his budget proposal to Congress.
Nearly Double
Use of all types of diagnostic imaging tests rose 44 percent in 2007 from 2002, nearly double the 23 percent growth in overall physician services per patient, the Medicare Payment Advisory Commission, or MedPAC, said in a March 2009 report to Congress.
The study measured use of nuclear heart scans, called SPECT MPI, or single-photon emission computed tomography myocardial perfusion imaging. Researchers used a computer program that weighed symptoms such as chest pain and factors such as age, high blood pressure, diabetes and history of smoking to identify unjustified tests. It flagged doctors when they didnt justify the test in some patients, the authors said.
“We need to be better stewards of our health-care dollar,” Ralph Brindis, a co-author of the report and senior adviser for cardiovascular disease at Northern California Kaiser Permanente, said in an interview. “To get the best kick for the buck, we want to do the right test for the right person at the right time.”
Use of the nuclear screens, developed 20 years ago, has been debated. MedPAC and other critics have focused on “self- dealing” specialist doctors who earn income from using their own diagnostic equipment.
Incentive to Use Them
“Once providers purchase machines, they have an incentive to use them as frequently as possible,” said MedPAC chairman Glenn M. Hackbarth in March 17 testimony to the subcommittee on health of the House Ways and Means Committee.
GE Healthcare, a unit of General Electric Co. in Fairfield, Connecticut; Philips Healthcare, a unit of Royal Philips Electronics in the Netherlands, and Siemens Healthcare, a unit of Siemens AG in Munich, Germany, are among companies that make the machines.
Study Funders
The study was funded by the American College of Cardiology Foundation and United Healthcare, a unit of UnitedHealth Group Inc. of Minnetonka, Minnesota, the largest U.S. supplier of medical benefits. The American Society of Nuclear Cardiology was also a partner in the study.
The research began in 2007. Doctors at six practices across the U.S. used computers to enter data on patients referred for nuclear heart scans that check for signs of heart disease.
The computers were equipped with a program containing guidelines on who should get the tests. The guidelines, previously drawn up by the cardiology college, incorporated almost 100 medical criteria and recommended the tests for people who had symptoms, such as pain while resting or that worsened during exercise, or heart rhythm disturbances, which suggested they had a high risk of coronary artery disease and imminent heart attack.
“Doctors are competitive souls; we dont want to be the ones with highest inappropriate numbers,” said study leader Robert Hendel, a cardiologist with Midwest Heart Specialists in Winfield, Illinois, and one of the authors of the study. Grading and feedback helped one medical practice group trim many unneeded tests to 13 percent from 22 percent, he said.
Alternative Test