High-billing cardiologists order more noninvasive testing when treating atrial fibrillation (AFib) than their colleagues, according to new data published in the Journal of the American Heart Association. This is not associated with better outcomes.
“These results suggest the importance of aligning reimbursement incentives with health system goals, because fee‐for‐service reimbursement may influence physician ordering behavior," wrote lead author R. Sacha Bhatia, MD, with the Institute for Health Systems Solutions and Virtual Care at Women’s College Hospital in Toronto, and colleagues.
Bhatia et al. tracked administrative claims data on cardiologists in Ontario, Canada, from April 2011 to March 2016.
The group was made up of 182,572 patients with AFib treated by 467 cardiologists. Fifty-eight percent of patients were men, and the median age was 74 years old.
The primary outcomes were patient‐level cardiac diagnostic and therapeutic procedures, while the secondary clinical outcomes were death, emergency department visits, and all‐cause hospitalization one‐year post‐index visit.
The authors found that the median annual billings per patient with AFib was wide-ranging, from $89 in quintile 1 (the lowest) to $463 in quintile 5 (the highest).
In the analysis, patients with AFib seen by higher‐billing cardiologists were 26% more likely to have an echocardiogram, 28% more likely to have a stress test, 25% more likely to undergo continuous electrocardiographic monitoring and 79% more likely to have a stress echocardiogram.
Those patients also had a higher rate of all‐cause hospitalization. However, mortality rates were pretty much the same among all cardiologists.
Bhatia et al. noted that the results of the study may have vital consequences for the clinical redesign of healthcare services to contain health costs.
“Our study suggests that some of this discretionary care in patients with AFib (testing in particular) may have a little impact on health outcomes, both in new consults and follow‐up patients," they wrote. "These results suggest that further outcomes‐oriented research into the optimal testing and management strategies—at the time of diagnosis and longitudinally—is required to ensure care is patient‐centered and cost effective.”
Read the full study here.