Self Referral: Another Installment

Today’s Managing Health Care Costs Indicator is 215%

Nuclear exercise stress tests are generally not recommended as “routine followup” after coronary revascularization.   However, cardiologists who were paid either professional fees (to read such tests) or who actually owned the equipment and were paid both technical and professional fees were 1.6-2.3 times more likely to order such tests, according to an article in last week’s Journal of the American Medical Association.  The same pattern was found for stress echo tests, which are performed much less frequently.

The authors looked for patients who were 90 days out from bypass or angioplasty, and found imaging tests performed within 30 days of a cardiologist office visit. They excluded patients with an intervening cardiac event.   This was from a large database of commercial claims, and the patients were on average between 54 and 55.

The authors note that the frequency of these tests in cardiologist offices increased 215% between 1998 and 2006, 181% in other physician offices, and only 32% in radiologist offices.

The physicians ordering these tests no doubt believed they were necessary.  Self referral has again been shown to lead to higher utilization and higher costs.  It also appears to be associated with lower levels of practicing evidence-based care.