Emily Bazar covers health care in California for Center for Health Reporting. She recently finished a series on the high rate of an elective heart procedure called angioplasty in California and how various groups are using data to look more deeply at health care costs. We caught up with her to talk about the project.
How did you come to focus your story on angioplasty, an elective heart procedure?
We were actually working off of an analysis of statewide hospital discharge data. This analysis looked at 13 elective procedures to find where the greatest variation was. By far, the greatest variation was with the rate of angioplasty and angiograms.
The community that I focused on, Clear Lake, had the highest rate in California–five or six times the state average. But then you had really big swaths of the Central Valley with rates of use of two, three, four times the state average.
What did you find after you began digging past the data, to the places and people?
When you go to these communities where there’s high variation in the rates of elective procedures like angioplasty, you will always hear that the reason for it is that the people in those communities are sicker, older, that they have more diabetes.
In the case of Clear Lake, a very troubled area, it’s true. There’s a lot of poverty. There’s a lot of drug use. There are a lot of people on Medicaid. There’s a big lake there, and there’s mercury in the water. This was the explanation I was getting from just about everybody.
But the experts generally say and agree that that’s not the only reason for the variation. Their studies adjust for factors that make geographies unique. Research has shown that it’s generally other factors that account for this variation.
John Wennberg, who founded the Dartmouth Atlas, has found one reason for this is often the “physician culture.” Doctors in different communities tend to prefer a certain treatments. I didn’t come up with any definitive answer to why this is, but lots of reasons came up:
One is fee-for-service, the way that the reimbursement model gives doctors and hospital the incentive to do more procedures.
Fresno papers who also reported on this found that doctors may have a population of patients that’s not necessarily the most compliant. When the doctors try an alternative–medication and healthier lifestyle–they say the patients don’t do that. Doctors de-facto become a little more aggressive in their treatment style. [Which often means opting for surgical procedures like angioplasty].
Access is sometimes an issue. People who don’t have a lot of access to health care will wait until their conditions become so acute until they need intervention. But that’s up to dispute, too, because unless you’re having a heart attack, angioplasty is considered elective surgery. Trials have shown it’s no better than medical therapy.
Data plays a big role in your story–how has data changed the landscape for those of us trying to better understand health care?
In California, the Office of Statewide Health Planning and Development keeps all of this hospital health charge data by year online. As a reporter or consumer, if you want to know what hospital has the highest rates of Cesarean sections, you can find it easily. You can find the length of stay in hospitals, or how many people leave a certain ER without being seen.
There is just a wealth of information out there not only for journalists, but for everybody.
What did you come away with in regard to the cost of health care?
I came away understanding that this kind of variation has a huge effect on the cost of health care.
If there are invasive or other medical procedures being done unnecessarily that adds to both cumulative costs, and to consumers. This comes back and hits the consumers because these things raise their premiums. It’s on both the macro level and the micro level that variations have a huge effect on health care costs.
It’s not just cost either. Putting people through a surgery, that takes a big toll on your body. It keeps you out of work. You can’t exercise. It impacts all parts of people’s lives.
(This interview has been edited and condensed).