The Case of Noninvasive Cardiac Testing—For Every Action There Is a Reaction

From 1999 to 2005, the use of noninvasive cardiac tests (NCTs), such as stress tests and echocardiography, grew by 57.1%, from 140 to 220 tests per 1000 patient-years, driven almost entirely by increased use of these tests in outpatient clinicians’ offices.¹ Concerned that this growth represented unnecessary overuse of testing, starting in 2005 the Centers for Medicare & Medicaid Services (CMS) reduced payments in the provider-based office (PBO) setting by half, from $600 to $300 per test on average. In this issue of JAMA Internal Medicine, Masoudi and colleagues¹ investigate how this change in Medicare reimbursement rates for NCTs influenced rates of these tests being performed in hospital-based outpatient (HBO) locations vs PBO locations.