Cardiac Procedures Done Without Verifying Necessity in Many Cases
Most elective angioplasties are performed without first conducting a noninvasive stress test to determine whether the procedure is necessary, according to a study published Wednesday in the Journal of the American Medical Association, the Milwaukee Journal Sentinel reports.
For the study, researchers analyzed 23,887 Medicare claims and 1,630 private insurance claims. Researchers found that 45% of Medicare beneficiaries received a stress test in the 90 days prior to their elective angioplasty, and 34% of privately insured patients received the test within one year of their procedure (Fauber, Milwaukee Journal Sentinel, 10/15).
The study also found that women, patients treated by younger physicians and patients treated by physicians that perform a large number of heart surgeries were less likely to receive a stress test (Thomas, Chicago Sun-Times, 10/15). Others that were less likely to receive a stress test were people ages 85 and older and patients with another cardiac condition, such as congestive heart failure or chronic obstructive pulmonary disease.
The study found that black patients and those with a history of chest pain were more likely to have the test (Ostrow/Nussbaum, Bloomberg News, 10/14).
In addition, the study found variations throughout the country with physicians in the Midwest and Northeast most likely to order stress tests (Chicago Sun-Times, 10/15).
The Journal Sentinel reports that the study "is the latest indication that elective angioplasty, which has increased by 300% over the last decade, has been overused" and sometimes is performed on patients "for whom the risk outweighs the benefit."
The study found that Medicare pays as much as $15,000 for each angioplasty, and the procedure accounts for at least 10% of the increase in Medicare spending since the mid-1990s (Milwaukee Journal Sentinel, 10/15).
According to an accompanying editorial, to avoid unnecessary angioplasties, guidelines should be clearer on when to conduct a stress test and Medicare payments should reflect how closely physicians follow those recommendations (Chicago Sun-Times, 10/15).
On Wednesday, NPR's "Morning Edition" reported on the study (Knox, "Morning Edition," NPR, 10/15).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.