Appropriate Use of Myocardial Perfusion Imaging in a Veteran Population

Abstract

in Canada. Direct-to-consumer advertising may have helped escalate niacin use, specifically Niaspan in the United States, with its prominent "intervention-style" ads. 11 Our study is limited in that we did not have access to patient-level data to determine whether niacin prescribing was clinically appropriate. Our study only evaluated the prescription niacin market; niacin use likely exceeds our estimates since some niacin products can be purchased over the counter. In conclusion, our study shows that prescription niacin sales are substantial and growing, even in the absence of contemporary supportive trial evidence. The discordance between sales and evidence should be a focus of professional dialogue about the role of this medication in the medical armamentarium.

Impact of Insurance Carrier, Prior Authorization, and Socioeconomic Status on Appropriate Use of SPECT Myocardial Perfusion Imaging in Private Community‐Based Office Practice

“…Second, our study indicates that higher reimbursement for SPECT‐MPI by commercial insurance carriers at the time of the study had no impact on appropriate use rates in this office‐based, fee‐for‐service setting. Our data are consistent with others from the Veterans Administration hospitals showing that lack of financial gains did not prevent high inappropriate use rates . Third, it has been shown that medical care and access to testing tightly correlates with education level, which is closely tied with income .…”

A Cohort Study of Myocardial Perfusion Imaging in Veteran Patients Without Symptoms

“… 4 Based on the available evidence, the AUC recognize that MPI is rarely appropriate for patients with no symptoms or stable symptoms. In a prior publication, we demonstrated that approximately 10% of nuclear MPI at our institution are inappropriate, 5 similar to reports from other facilities. 6 We also observed a substantial proportion of patients underwent MPI despite having no symptoms at the time.…”

Comparison of Payment Changes and Choosing Wisely Recommendations for Use of Low-Value Laboratory Tests in the United States and Canada

“…In particular, vitamin D screening in the US-Veterans population was higher than that in the US-Commercial population, whereas T3 testing in the US-Veterans population was substantially lower than that in the US-Commercial or CA-Ontario population. Previous studies have shown lower or similar rates of overuse in the VHA compared with Medicare . This lower rate of overuse is in part unsurprising because the VHA is a capitated system and neither the VHA facilities nor clinicians receive additional payments for performing laboratory tests.…”

“…Previous studies have shown lower or similar rates of overuse in the VHA compared with Medicare. [38][39][40] This lower rate of overuse is in part unsurprising because the VHA is a capitated system and neither the VHA facilities nor clinicians receive additional payments for performing laboratory tests. Under such conditions, focusing on saving resources for the system as a whole, policies that restrict test ordering, and evidence-based clinical decision support and/or other behavioral change interventions 41 may better yield desired decreases in low-value services.…”