Cardiologists perform fewer nuke tests due to tighter rules, fiscal constraints

Normal PET myocardial perfusion imaging (MPI) in coronary artery disease. Cardiac 13N-ammonia PET shows normal MPI at rest and at adenosine-stress but abnormal myocardial flow reserve, indicating global myocardial under perfusion. Source: J Nucl Med 2012;53(8):1230-1234

U.S. cardiologists are seeing more patients than ever before, yet performing, on average, fewer advanced nuclear tests on those patients, according to a joint survey from MedAxiom and the American Society of Nuclear Cardiology (ASNC). The survey respondents also cited a change in the approach to the delivery of cardiovascular care, as well as continued concerns about economic conditions as reasons for the decline.

More than 110 practices, representing more than 2,000 cardiologists, took part in the survey, which was released at ASNC’s annual conference, held last week in Baltimore.

The survey reveals that in 2011, on average, cardiologists recorded more than 2,100 patient visits, up more than 29 percent since 2004. 

At the same time, however, they performed an average of 356 imaging stress studies last year, such as stress echo tests, SPECT tests or PET tests to detect potential coronary problems such as blocked arteries or reduced pumping efficiency. That number remained, on average, largely flat over the same eight-year period, up only 2 percent.

Expressed as a ratio, however, the survey revealed that these tests were performed on one of every 11 cardiology patients last year, as opposed to one of every seven in 2008.

“Put simply,” the survey authors noted, “physicians are seeing more patients and performing fewer studies on those patients.” The study cited several reasons, such as:

• The increasing adoption of appropriate use criteria;
• Higher deductibles and copays for those with insurance;
• Increased awareness of radiation optimization;
• The use of provider-based billing by integrated cardiology practices; and
• An intermittent shortage of molybdenum-99.

“Cardiologists have been vigilant in prescribing the appropriate use of these tests as defined by initiatives such as Choosing Wisely,” said Patrick White, MedAxiom’s president. “As healthcare evolves in the U.S., we intend to continue working to help cardiologists and our corporate partners clearly define the patient-centered approach to cardiovascular imaging and optimize the value received from it.”

Look for a more in-depth perspective of the survey in the November issue of Cardiovascular Business.