A preauthorization program designed to reduce inappropriate use of myocardial perfusion imaging (MPI) cost cardiology practices $79,050 per 1,000 patients, an analysis presented at the American Heart Association scientific session in Dallas found.
Brendan R. Malik, MD, of Northeast Ohio Medical School in Rootstown, Ohio, and colleagues assessed the economic impact of a payer policy change implemented in September 2010 by a large health insurance provider in Western Pennsylvania, using a before and after comparison in the geographical coverage area. The new policy required preauthorization for MPI studies.
For their study, they collected the number of MPI studies, stress echocardiography studies and non-imaging exercise tests for the first quarter of 2010 and the first quarter of 2012. They used Medicare data to determine the total change in reimbursement per 1,000 patient studies, with reimbursement for MPI placed at $770 per study and stress echo at $355 per study. Costs included compliance with the policy, physician time, office staff time and overhead.
The policy succeeded in reducing MPI use. In the first quarter of 2010, 82.1 percent of patients underwent MPI studies and 17.9 percent had stress echo studies. By 2012, that had changed to 74.6 percent and 25.4 percent, respectively. Use of non-imaging exercise tests did not change.
But the payer initiative also increased the burden on practices. Malik et al determined that the policy change resulted in a loss of $29,050 from the shift in use of imaging modalities plus an additional $50,000 per 1,000 patients in compliance costs.
The researchers offered the findings in a poster presentation on Nov. 17.