A study published in the prestigious Journal of American Medical Association warns us that doctors may be placing patients in situations of unnecessary risks, partially due to their own economic incentives. Cardiologist Bimal R. Shah, M.D., from Duke University, was the lead author in the study that looked at the use of nuclear cardiac stress-testing following bypass surgery or other heart procedures in patients who showed no symptoms of coronary disease after their procedures.
Even though the American College of Cardiology recommends no early stress testing after these procedures if patients have no symptoms, doctors who owned the quarter-million dollar machines were twice as likely to order the procedure than doctors who did not own the machines. According to Dr. Shah, when ordering the test was left to the doctor’s discretion (i.e., when there were no symptoms to warrant the test) reimbursement made the doctors more likely to order the test, which can profit the dollar about $1,000 per procedure.
In addition to the risk of unecessary exposure, Dr. Shah noted a concern with false positives that could lead to even more medical care. The goal should be to eliminate all inappropriate testing.
It seems like more evidence to me that tort reform was a phoney argument in the debate of what has to change in order to bring down the cost of medicine in the United States.
