We spend a lot of time combating myths about how doctors make medical decisions. Among the most prominent of those delusions is the belief that doctors don't order extra treatments based on how they're paid--rather, all of their recommendations and prescriptions are based purely on the patient's need.
We've pretty thoroughly established by now that we don't buy it.
This article from last week's edition of JAMA doesn't buy it, either. The study compared rates of stress-testing as a follow-up after heart surgery, based on whether patients went to a practice that typically billed for such testing or didn't bill. The practice's billing patterns indicate whether they do the tests that they order in-house (and thus profit by the test), or if they send patients elsewhere. The results were striking: patients in practices that both performed and interpreted the tests in-house were about twice as likely to get a stress echocardiogram or nuclear stress test (two kinds of high-tech stress test, measuring the flow of blood through the heart). For stress echocardiography, in particular, patients at practices who did their own tests were almost 13 times as likely to get the test as patients who would have had to go elsewhere. The differences aren't based on different patient populations, either - the study included adjustments for age, sex, and prior medical conditions.
It's long past time to start thinking about payment reform.
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