CMS' decision to reduce payments for office-based noninvasive cardiac tests had the unintended consequence of increasing costs across the board, according to a study published in JAMA Internal Medicine.
Researchers conducted an observational claims-based study. They examined a mean of 1.72 million patient-years worth of Medicare fee-for-service claims data from 1999 to 2015 and a mean of 142,230 patient-years worth of Medicare Advantage claims from three health maintenance organizations from 2005 to 2015.
What you should know:
1. After the rule change, hospital-based testing increased from 21.2 percent in 2008 to 43.2 percent in 2015. Researchers noted a correlation to payment ratio.
2. However, hospital-based outpatient testing ratio for the managed care control group decreased from 16.6 percent in 2008 to 15.2 percent in 2015.
3. Researchers estimated the extra costs associated with the shift of tests to the hospital-based setting was $661 million in 2015, including $161 million in out-of-pocket costs.
Researchers concluded: "In settings in which reimbursement depends on test location, increasing hospital-based payments correlated with greater proportions of outpatient NCTs performed in the hospital-based outpatient setting. Site-neutral payments may offer an incentive for testing to be performed in the more efficient location."