Blue Cross Blue Shield Association Study Reveals Significant Cost Variations for Angioplasties

Consumers have lower cost, high-quality alternatives in many markets

CHICAGO – The cost of angioplasties — among the most common treatments for heart disease — varies widely in markets across the country, with significant variations emerging even within the same market area.

A new report by the Blue Cross Blue Shield Association (BCBSA) and Blue Health Intelligence (BHI) shows that prices for angioplasties or Percutaneous Coronary Interventions (PCIs) can cost more than five times as much depending on which hospital a patient chooses within a market. The analysis is based on independent Blue Cross and Blue Shield (BCBS) companies’ claims data.

While many angioplasty procedures are performed while a patient is experiencing a heart attack, the procedures studied in this report are not performed on such an urgent basis, making it possible for some individuals to consider both quality and cost as they choose the best facility for their care.

“A Study of Cost Variation for Percutaneous Coronary Interventions (Angioplasties) in the U.S.” shows the median typical cost for an angioplasty procedure was $27,144 in 86 of the 100 largest markets where claims data were available.* It could cost as little as $15,494 in Birmingham, Alabama, and as much as $61,231 in Sacramento, California.

Within a market, significant cost variation can also exist. In Los Angeles-Long Beach, California, an angioplasty could cost between $10,749 and $67,937 — a 532 percent cost variation — depending on the medical facility in which the procedure is performed.

Perhaps more importantly, data reveal that in markets with a high degree of cost variation, a significant volume of episodes occur at higher cost facilities. In the top five high-variation markets, findings showed that high cost facilities — those with median episode costs that are at least 20 percent above the median within each market — are home to a significant portion of the total episodes performed within the MSA. Further analysis indicates that there are other facilities in these same markets that deliver quality outcomes for patients at a lower cost.

Angioplasty is one of the most common procedures used in the treatment of heart disease. First developed in 1977, and in wide use since the 1990s, approximately one million are performed annually in the U.S. — making them a top ten contributor to healthcare costs, with expenditures totaling $10 billion in 2014, according to an American Heart Association report titled Heart Disease and Stroke Statistics: 2015 Update.  

“While progress has been made to reduce cardiac-related deaths in recent years, millions of Americans continue to need cardiac treatment and procedures,” said Trent Haywood, M.D., J.D., chief medical officer for BCBSA.  “Although some cardiac patients are not in a condition to shop for their procedure, the data show that many whose condition is less urgent have the ability to consider both quality and cost as they choose the best facility for their care.”

As the study shows, the hospital an individual selects has a direct impact on the total cost of a procedure. To help consumers identify high-quality, affordable hospitals, BCBS companies created the Blue Distinction® Centers+ designation, which recognizes hospitals that demonstrate expertise in delivering patient care safely and effectively and are also 20 percent more cost-efficient than non-designated facilities. There are nearly 250 Blue Distinction® Centers+ for Cardiac Care, and they are present in the majority of the markets that were studied. **

It is also critical that consumers have access to meaningful, credible information on medical practitioners. BCBS companies offer an array of transparency tools that provide standardized healthcare cost and quality information (including cost estimates, practitioner quality information, and access to patient reviews) enabling consumers to comparison shop for hundreds of common treatments and procedures. Members have access to consumer transparency tools on their BCBS company’s member portal or at the National Doctor and Hospital Finder.

The study on cost variation in angioplasties 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.

For more information on Blue Cross Blue Shield, The Health of America Report, visit www.bcbs.com/healthofamerica.

About Blue Cross Blue Shield Association
Blue Cross Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 106 million members – one in three Americans.  For more information on the Blue Cross Blue Shield Association and its member companies, please visit www.BCBS.com.  We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out The BCBS Blog for up-to-date information about BCBSA.

About BHI
Health Intelligence Company is the nation’s premier health intelligence resource, delivering data-driven insights about healthcare trends and best practices, resulting in healthier lives and more affordable access to safe and effective care. HIC accesses healthcare claims data from more than 140 million individuals nationwide, collected over nine years, in a safe, HIPAA compliant and secure database. The resulting conformed, reliable data set has the broadest, deepest pool of integrated medical and pharmacy claims, reflecting medical utilization in every ZIP code. Health Intelligence Company, LLC operates under the trade name Blue Health Intelligence (BHI) and is an Independent Licensee of BCBSA. For more information, visit https://www.bluehealthintelligence.com/.

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* This report examines medical claims for primary (non - Medicare) BCBS members incurred 36 months ending March 2014, paid through June 2014. Episode costs are based on total allowed amounts for related procedures and ancillary services for PCI without a heart attack for a period of time 30 days pre- and 90 days post-procedure across inpatient and outpatient facilities. Episodes are aggregated at a facility level based on their experience over 36 months. Only facilities with more than five episodes were included in the study. The data also limit scope of episodes it will measure in order to ensure comparability, creating a "normal" cohort. Episodes were dropped from the data where applicable, for patient age (<18 or >64), complicating conditions, non-continuous enrollment, and other criteria. 35,608 total episodes were included in this study.  Geographic groupings were done for Metropolitan Statistical Areas (MSA) as defined by the US Census Bureau. Complete data were unavailable for the states of New York, South Carolina, and Texas, thus they were excluded from this study.

** To learn more about Blue Distinction® Centers for Specialty Care, please visit www.bcbs.com or contact your Local Plan.