title: Association between physician billing and cardiac stress testing patterns following coronary revascularization.
abstract: BACKGROUND
  The degree to which financial factors may influence use of cardiac stress imaging procedures is unknown.
  
  
  OBJECTIVE
  To examine the association of physician billing and nuclear stress and stress echocardiography testing following coronary revascularization.
  
  
  METHODS
  Using data from a national health insurance carrier, 17,847 patients were identified between November 1, 2004, and June 30, 2007, who had coronary revascularization and an index cardiac outpatient visit more than 90 days following the procedure. Based on overall billings, physicians were classified as billing for both technical (practice/equipment) and professional (supervision/interpretation) fees, professional fees only, or not billing for either. Logistic regression models were used to evaluate the association between physician billing and use of stress testing, after adjusting for patient and other physician factors.
  
  
  METHODS
  Incidence of nuclear and echocardiographic stress tests within 30 days of an index cardiac-related outpatient visit.
  
  
  RESULTS
  The overall cumulative incidence of nuclear or echocardiography stress testing within 30 days of the index cardiac-related outpatient visit following revascularization was 12.2% (95% CI, 11.8%-12.7%). The cumulative incidence of nuclear stress testing was 12.6% (95% CI, 12.0%-13.2%), 8.8% (95% CI, 7.5%-10.2%), and 5.0% (95% CI, 4.4%-5.7%) among physicians who billed for technical and professional fees, professional fees only, or neither, respectively. For stress echocardiography, the cumulative incidence of testing was 2.8% (95% CI, 2.5%-3.2%), 1.4% (95% CI, 1.0%-1.9%), and 0.4% (95% CI, 0.3%-0.6%) among physicians who billed for the technical and professional fees, professional fees only, or neither, respectively. Adjusted odds ratios (ORs) of nuclear stress testing among patients treated by physicians who billed for technical and professional fees and professional fees only were 2.3 (95% CI, 1.8-2.9) and 1.6 (95% CI, 1.2-2.1), respectively, compared with those patients treated by physicians who did not bill for testing (P < .001). The adjusted OR of stress echocardiography testing among patients treated by physicians billing for both or professional fees only were 12.8 (95% CI, 7.6-21.6) and 7.1 (95% CI, 4.0-12.9), respectively, compared with patients treated by physicians who did not bill for testing (P < .001).
  
  
  CONCLUSIONS
  Nuclear stress testing and stress echocardiography testing following revascularization were more frequent among patients treated by physicians who billed for technical fees, professional fees, or both compared with those treated by physicians who did not bill for these services.
authors: Duke Clinical Research Institute and Division of Cardiovascular Medicine, Duke University Medical Center, Durham, North Carolina 27705, USA. bimal.shah@duke.edu
authors: Bimal R
authors: BR
authors: Shah
authors: Patricia A
authors: PA
authors: Cowper
authors: Sean M
authors: SM
authors: O'Brien
authors: Neil
authors: N
authors: Jensen
authors: Manesh R
authors: MR
authors: Patel
authors: Pamela S
authors: PS
authors: Douglas
authors: Eric D
authors: ED
authors: Peterson
mesh_terms: D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D004452:Echocardiography; D025401:Echocardiography, Stress / Q000191:economics* / Q000706:statistics & numerical data*; D005249:Fees and Charges / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D038801:International Classification of Diseases / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging; D010045:Outpatients / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011877:Radionuclide Imaging; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies