CASE v6.6 Cardiac Assessment
System for Exercise Testing
from GE Healthcare.
System for Exercise Testing
from GE Healthcare.
Choosing Wisely : Examining the value of stress tests
June 29, 2012
by Diana Bradley, Staff Writer
The American Board of Internal Medicine Foundation
unveiled its Choosing Wisely initiative in April, cautioning doctors and patients to question the necessity of 45 routine medical tests — including cardiac stress tests.
Nine leading medical specialty societies, including the American College of Cardiology and American Society of Nuclear Cardiology, created lists of “Five Things Physicians and Patients Should Question,” to help spread the campaign’s message. But they don’t want to abolish stress testing completely, according to Dr. Robert Hendel, chair of the committee that wrote the ASNC’s list of suggestions and member of the ACC’s appropriate use criteria task force.
“We should be watching how stress tests are used because they are expensive and they cause potential problems for patients and society,” says Hendel, director of the University of Miami Hospital’s Cardiovascular Intensive Care Unit and the director of cardiac imaging and outpatient services for the University of Miami Miller School of Medicine’s cardiovascular division. “On the other hand, we also know they produce great benefits; we don’t want these tests to disappear and we want to make sure they are accessible to people that truly need them. We need to have a greater focus on patient safety.”
According to a 2010 Consumer Reports survey of approximately 1,200 people aged 40 to 60 with no history of heart disease or heart disease symptoms, during the previous five years, 39 percent had undergone an EKG and 12 percent had an exercise stress test.
Inaccurate results may be produced from these tests, triggering risky follow-up tests such as CT and coronary angiography, exposing patients to notable radiation levels.
“Manufacturers are doing a great job in developing new equipment that reduces patients’ radiation exposure,” says Hendel. “But the very best way to reduce radiation exposure is to just not do the tests. So if a patient doesn’t need it, we won’t do it at all. The field becomes stronger, more legitimized and credible.”
Adding to the considerations is the price of testing – a particular sore spot when deemed unnecessary. An exercise stress test can cost upwards of $300, while an EKG can go to the tune of $50, says HealthcareBlueBook.com. In fact, a Mayo Clinic study, published in April by the American Heart Association Journal, found that $8 billion dollars is spent in health care costs on the six million patients admitted to emergency rooms each year with chest pain. The study’s use of a “decision aid” — a tool that educates patients about their treatment — found that patients opted to be admitted for stress testing 58 percent of the time, as opposed to the 77 percent of patients who were not counseled.
“If a person is going for low-risk surgical procedures like a biopsy, or glaucoma surgery, they don’t need a stress test or stress imaging test, so we are encouraging both the consumers and physicians that this is just not something that should be done,” says Hendel. “Likewise, if someone has no chest pain or no shortness of breath after they walk up a flight of stairs, and they are not a high-risk person like a diabetic, then there is no reason they should have a stress imaging test. And you may say, ‘Of course that is correct,’ but the reality is, unnecessary tests are still being done.”
It appears that the over-utilization of stress tests may come down to the fact that doctors merely want to cover their assets. According to a study in a September 2011 issue of the Archives of Internal Medicine, 80 percent of surveyed doctors said they do this out of fear they might get sued for malpractice. But the Choosing Wisely campaign is already transforming the industry.
“We know we are already having an impact as we have seen a reduction of inappropriate test volume in one instance from 10 percent to 5 percent – that’s a 50 percent reduction, exactly what the target was at the White House Summit two years ago when the American College of Cardiology’s president met with the Obama administration and committed to reducing inappropriate testing by 50 percent in three years,” Hendel says. “We did it in one year. That was only a small sample and it’s not that way everywhere, but we believe this is an achievable goal.”
The campaign will lead to a slight decline in testing volume, but Hendel explains this will eventually lead to more and better access for patients who need it. In spite of this, OEMs remain unfazed by the campaign’s threat to the sector.
“Although [the campaign] may have some impact on the stress test sector, I am not too worried about the affect on sales,” notes Melanie Varin, general manager of U.S. sales and marketing, diagnostic cardiology, Life Care solutions for GE Healthcare.
Varin’s own uncle – a seemingly low-risk patient, the “epitome of health” – was given a stress test after a physical found some abnormalities. The test showed he had significant blockage and he was essentially labeled a “walking time bomb.” Within a day, he was undergoing triple bypass surgery.
Choosing Wisely highlights stress cardiac imaging, which is a stress test in combination with an echo test or a nuclear test. In Varin’s uncle’s case, the stress test was done without any of the other imaging procedures, but remained effective in uncovering a significant issue. When done on its own, stress testing is a cost-effective way to understand what a patient’s heart rhythm is doing when under stress, says Varin.
“Echo tests and nuclear tests are very appropriate and make sense when indication suggests they will uncover additional information,” she adds.
Regardless of the campaign, Michael K. Moore, VP of sales for Nasiff Associates, Inc., says facilities and practices will still need equipment necessary for diagnostic testing.
“Physicians clearly have a responsibility to provide high value, cost conscious care,” says Moore. “It’s all about good judgment, not curtailing care. Physicians will be held accountable to make wise decisions about the most appropriate care based on their patient’s individual situation.”
Names in boldface are Premium Listings.
Domestic
Joe Avina, AMERICAN INTERNATIONAL MEDICAL, CA
DOTmed Certified
DOTmed 100
Alda Clemmey, Saffire Medical, MA
DOTmed Certified
DOTmed 100
John Gladstein, Medical Device Depot, MD
DOTmed Certified
Boyd Campbell, Southeastern Biomedical Associates, Inc., NC
DOTmed Certified
Robert Schirano, Finger Lakes Medical Supply LLC, NY
Lawrence Maroney, Integris Equipment, NY
DOTmed Certified
Anita Bourdeau, Nasiff Associates, Inc., NY
unveiled its Choosing Wisely initiative in April, cautioning doctors and patients to question the necessity of 45 routine medical tests — including cardiac stress tests.
Nine leading medical specialty societies, including the American College of Cardiology and American Society of Nuclear Cardiology, created lists of “Five Things Physicians and Patients Should Question,” to help spread the campaign’s message. But they don’t want to abolish stress testing completely, according to Dr. Robert Hendel, chair of the committee that wrote the ASNC’s list of suggestions and member of the ACC’s appropriate use criteria task force.
“We should be watching how stress tests are used because they are expensive and they cause potential problems for patients and society,” says Hendel, director of the University of Miami Hospital’s Cardiovascular Intensive Care Unit and the director of cardiac imaging and outpatient services for the University of Miami Miller School of Medicine’s cardiovascular division. “On the other hand, we also know they produce great benefits; we don’t want these tests to disappear and we want to make sure they are accessible to people that truly need them. We need to have a greater focus on patient safety.”
According to a 2010 Consumer Reports survey of approximately 1,200 people aged 40 to 60 with no history of heart disease or heart disease symptoms, during the previous five years, 39 percent had undergone an EKG and 12 percent had an exercise stress test.
Inaccurate results may be produced from these tests, triggering risky follow-up tests such as CT and coronary angiography, exposing patients to notable radiation levels.
“Manufacturers are doing a great job in developing new equipment that reduces patients’ radiation exposure,” says Hendel. “But the very best way to reduce radiation exposure is to just not do the tests. So if a patient doesn’t need it, we won’t do it at all. The field becomes stronger, more legitimized and credible.”
Adding to the considerations is the price of testing – a particular sore spot when deemed unnecessary. An exercise stress test can cost upwards of $300, while an EKG can go to the tune of $50, says HealthcareBlueBook.com. In fact, a Mayo Clinic study, published in April by the American Heart Association Journal, found that $8 billion dollars is spent in health care costs on the six million patients admitted to emergency rooms each year with chest pain. The study’s use of a “decision aid” — a tool that educates patients about their treatment — found that patients opted to be admitted for stress testing 58 percent of the time, as opposed to the 77 percent of patients who were not counseled.
“If a person is going for low-risk surgical procedures like a biopsy, or glaucoma surgery, they don’t need a stress test or stress imaging test, so we are encouraging both the consumers and physicians that this is just not something that should be done,” says Hendel. “Likewise, if someone has no chest pain or no shortness of breath after they walk up a flight of stairs, and they are not a high-risk person like a diabetic, then there is no reason they should have a stress imaging test. And you may say, ‘Of course that is correct,’ but the reality is, unnecessary tests are still being done.”
It appears that the over-utilization of stress tests may come down to the fact that doctors merely want to cover their assets. According to a study in a September 2011 issue of the Archives of Internal Medicine, 80 percent of surveyed doctors said they do this out of fear they might get sued for malpractice. But the Choosing Wisely campaign is already transforming the industry.
“We know we are already having an impact as we have seen a reduction of inappropriate test volume in one instance from 10 percent to 5 percent – that’s a 50 percent reduction, exactly what the target was at the White House Summit two years ago when the American College of Cardiology’s president met with the Obama administration and committed to reducing inappropriate testing by 50 percent in three years,” Hendel says. “We did it in one year. That was only a small sample and it’s not that way everywhere, but we believe this is an achievable goal.”
The campaign will lead to a slight decline in testing volume, but Hendel explains this will eventually lead to more and better access for patients who need it. In spite of this, OEMs remain unfazed by the campaign’s threat to the sector.
“Although [the campaign] may have some impact on the stress test sector, I am not too worried about the affect on sales,” notes Melanie Varin, general manager of U.S. sales and marketing, diagnostic cardiology, Life Care solutions for GE Healthcare.
Varin’s own uncle – a seemingly low-risk patient, the “epitome of health” – was given a stress test after a physical found some abnormalities. The test showed he had significant blockage and he was essentially labeled a “walking time bomb.” Within a day, he was undergoing triple bypass surgery.
Choosing Wisely highlights stress cardiac imaging, which is a stress test in combination with an echo test or a nuclear test. In Varin’s uncle’s case, the stress test was done without any of the other imaging procedures, but remained effective in uncovering a significant issue. When done on its own, stress testing is a cost-effective way to understand what a patient’s heart rhythm is doing when under stress, says Varin.
“Echo tests and nuclear tests are very appropriate and make sense when indication suggests they will uncover additional information,” she adds.
Regardless of the campaign, Michael K. Moore, VP of sales for Nasiff Associates, Inc., says facilities and practices will still need equipment necessary for diagnostic testing.
“Physicians clearly have a responsibility to provide high value, cost conscious care,” says Moore. “It’s all about good judgment, not curtailing care. Physicians will be held accountable to make wise decisions about the most appropriate care based on their patient’s individual situation.”
DOTmed Registered 2012 - June - Stress Test Companies
Names in boldface are Premium Listings.
Domestic
Joe Avina, AMERICAN INTERNATIONAL MEDICAL, CA
DOTmed Certified
DOTmed 100
Alda Clemmey, Saffire Medical, MA
DOTmed Certified
DOTmed 100
John Gladstein, Medical Device Depot, MD
DOTmed Certified
Boyd Campbell, Southeastern Biomedical Associates, Inc., NC
DOTmed Certified
Robert Schirano, Finger Lakes Medical Supply LLC, NY
Lawrence Maroney, Integris Equipment, NY
DOTmed Certified
Anita Bourdeau, Nasiff Associates, Inc., NY