When noninvasive heart tests were shifted to a hospital-based outpatient facility, overall costs as well as patients' out-of-pocket expenses increased, according to a study published in JAMA Internal Medicine.
In 2005, CMS began reducing Medicare fee-for-service payments for noninvasive cardiac tests performed in provider-based offices in an attempt to control spending. At the same time, payments for hospital-based outpatient testing increased. For the study, researchers reviewed Medicare fee-for-service claims from 1999 to 2015 to identify trends in payment rates for outpatient noninvasive cardiovascular tests. They also compared how the rates stacked up against provider-based office testing.
"In settings in which reimbursement depends on test location, increasing hospital-based payments correlated with greater proportions of outpatient [noninvasive cardiac tests] performed in the hospital-based outpatient setting," the authors said.
They estimated shifting tests to the hospital-based outpatient setting led to extra costs of $661 million in 2015, including $161 million in out-of-pocket costs for patients.
"Site-neutral payments may offer an incentive for testing to be performed in the more efficient location," the authors concluded.
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