As one cardiologist puts it, "At many hospitals, the threshold for ordering an echocardiogram is the presence of a heart." That statement, made to the New York Times, becomes all the more troubling if you read the Times' full look into the use—and generally wildly varying cost—of the scan, which employs sound waves to produce an image of the heart. In contrast with other common tests (colonoscopies, MRIs) there are no pain or risks involved. And the once-pricey machines have, over the past several decades, become much less expensive. Modern Healthcare in October put the average cost of a cardiac ultrasound machine at $140,000, which it sees fueling their popularity in doctors' offices and clinics "that still get the majority of their reimbursement from fee-for-service medicine."
But as one Tokyo doctor with ties to University of Pennsylvania's business school puts it, "One of the things about the US health care system is that it defies the laws of economics, and of gravity. Once the price is high, it just stays there." To wit, the test now costs $50 to $88 in Japan, which sets the allowable prices. But one New Jersey 76-year-old tells the Times that his two recent scans (one done near his home, one in Boston) cost $5,500 and $1,400, respectively. Medicare has tried to keep costs down by setting the payment for echocardiograms performed in doctors’ offices at just $92. As a result, more scans are happening in outpatient hospital settings, where the allowable Medicare fee is higher. Doctors don't necessarily lose out because they can charge their non-Medicare patients much more; in Philly, the Times found prices as high as $12,000. Full story here.