Nuclear testing rates were about 50 percent higher among physicians who just billed for professional services versus those who didn't bill for either, he added.
Testing did tend to be more common among patients who had symptoms, although up to 10 percent of patients in this study who underwent testing had no symptoms.
Shah acknowledged that more current data need to be obtained, given that guidelines as well as Medicare/Medicaid reimbursement have changed since the study was finished.
And some of the testing may indeed have been necessary, given that billing information can only reveal so much about a patient's overall status.
"There are certainly reasons that patients may be getting tested: patient reassurance, physician reassurance or [if an employer requires it] before returning to work," Shah said. But there were large variations, he noted.
"This has been a concern for a long time, [but] how important this is financially and from a risk perspective may be overemphasized," said Dr. Robert Hendel, a professor of medicine and radiology and director of cardiac imaging at the University of Miami School of Medicine. "We have made great strides [since 2007] to make people aware that we have to be much more concerned about how we utilize testing both in terms of risk and extent."
Regardless of the issue of reimbursement, though, "the bigger issue is that we want to discourage all inappropriate testing," Hendel said.
The U.S. National Library of Medicine has more on nuclear stress testing.
SOURCES: Bimal R. Shah,
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