Trends in High- and Low-Value Cardiovascular Diagnostic Testing in Fee-for-Service Medicare, 2000-2016

Area of Science:

• Cardiovascular Medicine
• Health Services Research
• Health Economics

Background:

• The Centers for Medicare & Medicaid Services (CMS) implemented payment changes to control rising diagnostic cardiovascular testing costs.
• The impact of these payment changes on guideline-concordant cardiovascular testing remained unclear.

Purpose of the Study:

• To evaluate the association between CMS payment changes and trends in overall, high-value, and low-value diagnostic cardiovascular testing.
• To determine if payment reforms affected guideline-recommended testing rates.

Main Methods:

• Retrospective cohort study using a 5% national random sample of Medicare fee-for-service beneficiaries (ages 65-95).
• Analysis of diagnostic cardiovascular testing rates from 1999 to 2016.
• Assessment of high-value testing (e.g., LV systolic function in MI/HF) and low-value testing (e.g., pre-surgery stress tests, routine tests post-revascularization).

Main Results:

• Overall diagnostic cardiovascular testing rates increased initially (2000-2008) then declined (2008-2016).
• High-value testing rates consistently increased for acute myocardial infarction and heart failure patients.
• Rates of low-value testing generally decreased after an initial rise, particularly post-2008.

Conclusions:

• CMS payment changes appear to have coincided with a decrease in overall and low-value diagnostic cardiovascular testing.
• High-value, guideline-recommended cardiovascular testing rates showed a slight increase.
• Payment reforms aimed at cost reduction did not appear to negatively impact guideline-concordant cardiovascular testing.