Cost Variations in Cardiac Care: Overview
Cardiovascular disease is a leading cause of death and disability in the United States, responsible for 610,000 deaths — 1 in 4 — every year. Though much of heart disease is preventable by adopting healthier behaviors, and significant progress has been made in reducing deaths in recent years, millions of Americans continue to need cardiac treatment and procedures. The cost of this care is expected to reach $918 billion by 2030 — an increase of almost 200 percent from 2010.
One of the most common procedures used in the treatment of heart disease is percutaneous coronary intervention (PCI) or angioplasty with and without stents. First developed in 1977, and in wide use since the 1990s, approximately one million angioplasties are performed annually in the U.S. — making them a top ten contributor to healthcare costs, with expenditures totaling $10 billion in 2014. In addition, according to the Journal of the American Medical Association, 1 out of 8 of these procedures is medically unnecessary and inappropriate.1
This Health of America Report analyzed three years of independent Blue Cross and Blue Shield (BCBS) companies’ claims data for angioplasties.2
The report examined angioplasties performed among patients who were not experiencing a heart attack, in both inpatient and outpatient facilities, across 86 of the 100 largest Metropolitan Statistical Areas (MSAs) where data were available. The findings reveal that even after adjusting for geographic differences in business costs, angioplasty episode costs vary widely both within and across MSAs.
Variations in cost within a market are significant, varying by as much as 532 percent. While the phenomenon of cost variation in healthcare is well-known and high costs are the result of many factors — including an aging population, new treatments, and technologies — data reveal that in markets with a high degree of cost variation, a significant volume of episodes occur at higher cost facilities.
Further analysis indicates that there are other facilities in these same markets that deliver quality outcomes at a lower cost.
These findings reinforce the importance of competition within a market and the need to provide consumers with effective tools to help them make informed decisions about their care.
Many angioplasties nationally are performed while a patient is suffering a heart attack. This analysis focuses solely on those procedures performed under less urgent conditions, making it possible for consumers to consider both cost and quality in choosing the best facility for their care. Cost and quality information are included in many transparency tools to inform consumers on where to seek high-quality, affordable care.
Variation in cost across markets is also significant and can vary by as much as 295 percent. This continues to concern national employers seeking solutions that help their employees in choosing quality settings for their care, while reducing overall costs.
This is the second report by Blue Cross Blue Shield, The Health of America Report, a collaboration between the Blue Cross Blue Shield Association and Blue Health Intelligence, which uses a market-leading claims database to uncover key trends and provide insight into healthcare affordability and access to care. These insights also point to where Blue Cross and Blue Shield (BCBS) innovations can address pressing market issues.