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Invited Commentary
October 14, 2019

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

Author Affiliations
  • 1Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
  • 3Center for Health Economics and Policy, Institute for Public Health at Washington University, St Louis, Missouri
JAMA Intern Med. 2019;179(12):1706-1707. doi:10.1001/jamainternmed.2019.4265

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.

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