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Choosing Wisely : Examining the value of stress tests

by Diana Bradley, Staff Writer | June 29, 2012
From the June 2012 issue of HealthCare Business News magazine

“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.

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