Should heart disease screening tests be covered by insurance?

Tremendous controversy surrounds the screening for cardiac disease.

The USPSTF does not recommend heart screening tests for the general population, like a routine EKG or exercise stress test. Texas, however, takes the opposite approach. They recently passed the Texas Heart Attack Prevention Bill (via Schwitzer), “mandating health-benefit plans to provide coverage for certain screening tests for early coronary artery disease.”

Indeed, some of the wording of the bill endorses tests that have little consensus evidence to support them, including stipulations that, “health-benefit providers cover the cost of CT coronary-artery-calcium (CAC) scans and carotid ultrasonography in men between the ages of 45 and 76 and women between the ages of 55 and 76, as well as anyone (at any age) who has diabetes or is deemed to be at intermediate risk or higher for developing CAD.”

This is somewhat troubling since there is little data that I’m aware of showing a mortality benefit to screening the general population with CAC scans and carotid ultrasounds.

It is curious that the professional societies involved, namely, the AHA and ACC, have differing levels of support, with the ACC supporting the legislation, and the AHA taking a neutral stance.

What’s left unsaid is the financial impact, where both cardiologists and primary care doctors will be compelled to order these expensive tests, with controversial evidence that they will actually help patients.

Over the weekend, Steve Jacob writes a scathing op-ed in the Fort Worth Star-Telegram (again, via Schwitzer) on the measure:

Applying the new Texas mandate of $200, finding one stroke would cost more than $869,000, and more than $1.7 million would be spent to prevent the disabling stroke. Think Texas Lottery odds: one “winner,” 8,695 losers who bore the costs and screening risks.

This is the sort of logic — and expense — we will be employing on Sept. 1. It is also a giant stride in the wrong direction, away from evidence-based and cost-effective medicine.