Cost and appropriateness of radionuclide exercise stress testing by cardiologists and non-cardiologists.
The hypothesis that a diagnostic evaluation performed by a generalist is less expensive than that performed by a specialist is untested. We retrospectively evaluated the indications and financial ramifications of radionuclide exercise stress testing by cardiologists and noncardiologists in 1,902 consecutive adults with normal resting electrocardiograms. Subjects completed radionuclide exercise tests for the diagnosis or management of coronary artery disease during a 14-month period. Tests were considered "indicated" or "not indicated" based on criteria determined from published reports and established practice guidelines. Savings in costs and charges were determined for a strategy of referral to a cardiologist before ordering tests. Non-cardiologists ordered more tests that were not indicated than cardiologists (69.6% vs 36.2%, chi-square = 209.07, p < 0.00001). Non-cardiologists also ordered tests that were not indicated in patients with (chi-square = 110.02, p < 0.00001) and without (chi-square = 110.02, p < 0.00001) and without (chi-square = 45.44, p < 0.00001) chest pain. Tests that were not indicated resulted in excess costs of $591,384 and excess charges of $1,082,400. Referral to a cardiologist before ordering tests could have saved $63,257 in costs and $169,800 in charges. Both cardiologists and non-cardiologists overutilized radionuclide exercise stress test; however, non-cardiologists were more likely to order tests that were not indicated. A strategy of referral to a cardiologist before ordering tests may be cost-effective in this population.
Department of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
J H
JH
Stein
E F
EF
Uretz
J E
JE
Parrillo
J T
JT
Barron
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology / Q000191:economics*; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000191:economics; D005080:Exercise Test / Q000191:economics* / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007087:Illinois; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000191:economics*; D011877:Radionuclide Imaging; D012017:Referral and Consultation; D012189:Retrospective Studies