THE TOP NINE LIST

WHY SHOULD I PERFORM
CARDIOPULMONARY EXERCISE TESTING?

 

9.
   The test focuses on the physiologic and anatomical aspects of an individual’s medical condition. Other tests focus just on anatomy and try to draw correlations to physiology.
 

8.
   Estimating METS by using the traditional Cardiac Stress Test leads to a systematic error of 10 – 92%. Cardiopulmonary Exercise Testing eliminates this error by measuring METS.
 

7.
   There is virtually no correlation between Treadmill Time and measured METS. “Clinicians should be aware that prediction equations for functional capacity were developed using healthy subjects.”
 

6.
   The cost to the patient is lower than Stress Echo, Stress Thallium, or Coronary Caths. The Cardiopulmonary Stress Test does not replace the need for these services, but it will identify those that are at a risk low enough to question whether the need is justified.
 

5.
   Results separate out the primary cause of dyspnea (answers the question: Is it the heart, lungs, both, or physical deconditioning?)
 

4.
   Results are specific to show that a negative test is truly negative (95% of the time). Since most individuals seen in primary care are physically deconditioned, lacking significant heart or lung disease, this test reassures the patient and physician that nothing more needs to be done (in terms of expensive interventions vs. inexpensive lifestyle modifications.)
 

3.
   According to the Social Security Administration: “When the results of tests with measurement of oxygen uptake are available, every reasonable effort should be made to obtain them.”
 

2.
   Reimbursement for a combined Cardiopulmonary Exercise Test and Pulmonary Function Test increase your practice revenue ranging from Medicare to traditional private pay insurers.
 

1.
  

If you measure METS, three things happen:
 
 

 
a. Meaningful compensation for your practice to measure METS and not estimate them.
   
b.
  

The systematic error (10-92%) associated with traditional Cardiac Stress Tests is eliminated.
   
c.
  

Referrals to Specialists are eliminated for individuals that don’t really need them, and referrals are made for those that do (the net effect is that you should see a small – 15% -- increase in cardiac and pulmonary referrals as you uncover latent disease). Cardiologists and Pulmonologists would rather spend time “working up” new patients that need their services than “working up” those that don’t.