Echocardiogram or electrocardiogram? One difference is cost, Medicare reimbursement

A cynic might believe that doctors perform more (perhaps not entirely necessary?) services to compensate for the declining amount of money they make through reimbursement. But a new study reveals a variation on the theme of doctors-finding-ways-to-bring-in-more-money.

They perform fewer of the less-profitable services (such as electrocardiograms) in favor of doing more of the more-profitable services (such as echocardiograms.)

"In other words, they are pumping up the volume where it counts," writes Robert Lowes in this Medscape story.

Before we move forward, let's understand the differences between an electrocardiogram, EKG, and an echocardiogram. The EKG reveals the electrical activity of the heart. Patients have a series of electrodes pasted on their skin, which produce a line tracing with bumps on the EKG monitor. Each bump shows the electrical function through a certain portion of the heart. For the "echo," patients will have a transducer rolled over their chest. Sound waves are collected and used to project a two-dimensional image of the beating heart and reveal how well it functions. Some variations of the test also show electrical activity, which drives the function of the heart.

The study about "Medicare Fees and the Volume of Physicians' Services"--published in Inquiry, the Journal of Health Care Organization, Provision and Financing--looked at eight services physicians provide and surveyed 13,707 doctors in 2000, and in 2005, during a time when Medicare rates dropped by 11 percent, compared to costs.

Read the abstract for yourself.

Researchers noted a shift in all eight of the services, but most dramatic in the cardiac tests. Lowes reports "a 7.6 percent decrease for electrocardiograms and a 50.9 percent increase for echocardiograms. Medicare is reimbursing physicians $9.02 on average for a standard electrocardiogram, coded 93010, and $154.08 for an echocardiogram, coded 93307."

The study did not give the costs of providing electrocardiograms and echocardiograms. But it kinda makes you wonder...

I'm not sure this is a case of doctors being greedy. Maybe they're just balancing the practice books the only way Medicare allows; and maybe they're a little spoiled by the availability of the higher-tech echocardiogram. Maybe it's also a case of Medicare not staying on top of its own reimbursement rates, not paying a realistic amount. If you have both services at your disposal and one pays you $9 and the other pays you $154--which would you do?

Non-cynics might say they'd choose what was best for the patient. But that's not clear cut. The EKG might be adequate to diagnose the patient's complaint. But the echocardiogram will give a more complete picture. And sometimes both are needed.