Angioplasties in California: What Do They Say About Health Costs?

Patrick J. Lynch via Flickr

Here at ClearHealthCosts.com, we regularly look at how geography affects the cost of a procedure like Lasik, or a pharmaceutical, as we have through the Price of Birth Control project.

But geography does more than shape the cost of a procedure–it also impacts whether or not you will have a certain procedure. Data mining has shown huge variations in the frequency of some health procedures by region. This has big implications for the cost of health care, “raising the prospect that billions of dollars are wasted each year on unnecessary and potentially dangerous treatments.”

This revelation comes out of some terrific work by the California HeathCare Foundation Center for Health Reporting, based at the USC Annenberg School for Communication and Journalism. Emily Bazar, one of the Center’s senior reporters, recently had a two-part series in the San Francisco Chronicle that began by looking at the cost of care through the lens of health procedures in Clearlake, a small Northern California lake town found to have an abnormally high incidence of a certain kinds of elective heart procedure.

An analysis of statewide hospital data by Stanford Professor Laurence Baker found that Clearlake saw an unusually high number of two elective heart procedures. Moreover, a separate analysis of Medicare data revealed that from 2005 to 2007, Clearlake had the highest inpatient angioplasty rate in the nation.

(A subseqent investigation by Consumer Reports found widespread overuse of invasive heart

procedures, which brought in huge profits for doctors while sometimes putting patients at unnecessary risk.)

This high rate of elective surgery comes with a meaty price tag. Bazar notes that median price for a scheduled, inpatient angioplasty in 2009 was $71,166 at St. Helena Hospital, where the overwhelming majority of Clearlake residents traveled to have their heart procedures. That price tag is in line with many Northern California hospitals. So it was less the cost of a single procedure than the fact that some places seemed particularly prone to procedures others often deemed unnecessary that caught researchers’ attention. As Bazar explains:

“The financial and health implications of extreme variation are enormous, raising the prospect that billions of dollars are wasted each year on unnecessary and potentially dangerous treatments. About 600,000 angioplasties alone are performed nationwide annually at a price tag of more than $12 billion, according to a recent study in the Journal of the American Medical Association.”

Not surprising then that organizations are using data mining to try to control costs. The second piece in Bazar’s series looks at an experiment in San Francisco in which Blue Shield of California has partnered with local hospitals and physicians to try coordinate care for 26,000 public employees in the hopes of improving care while eliminating waste.

Bazar did several blog posts on the heels of her reporting, highlighting the varied responses to her pieces, and taking a deeper look at the procedure of elective angioplasty. Take a look at Bazar’s work. We will be talking with her soon about how she went about doing her reporting, and other issues around cost of care.