Heart procedures are difficult and costly, and they are especially costly depending on what part of the country a patient lives in.
A report from the Blue Cross and Blue Shield Association (PDF) shows that the amount paid for angioplasties varies widely nationwide. Often, the payment discrepancies were sharp in the same market.
Blue Cross evaluated the medical claims for all non-Medicare members over the past three years, focusing specifically on patients who underwent an angioplasty and did not have a heart attack soon after. Angioplasties are heart procedures that clear up blocked arteries and routinely involve the use of stents.
The report is significant because it shines a light on what is normally the black box of healthcare: the amount an insurer actually paid to the hospital or doctor, not merely the provider's charges. Medicare has started showing what it pays providers, as well as what the provider's charges are, but the trend has not yet permeated among private insurers.
The median amount that a Blue Cross insurer paid for an angioplasty in Los Angeles was between $10,749 and $67,937, a 532% difference and the most extreme variation in the report. In Chicago, Blue Cross reimbursed providers between $15,951 and $49,604 for the same types of angioplasties, a 211% difference. There were 39 metropolitan areas in which angioplasty payments varied by at least 100%.
Angioplasties cost the most in Sacramento, Calif. The median cost for an angioplasty episode of care in California's capital was $46,506. The cheapest angioplasties were in Birmingham, Ala., costing Blue Cross about $15,495 for every procedure on average.
The data mirror a BCBSA report from earlier this year, which highlighted the pricing variations among hip and knee surgeries. Dr. Trent Haywood, chief medical officer of the association, said the angioplasty report did not focus on the causation behind the wide variation. For example, no reason was given for why a Blue Cross insurer would pay some providers much more than others in the same area even though the procedures are the same.
But Haywood noted that high-cost facilities influenced some of the data. “The more transparency around this, the more that providers will start to address this particular issue,” he said.
Haywood also said airing price and quality data will “galvanize” consumers to make better choices for elective care, and quality and affordability are not mutually exclusive.
The BCBSA, which insures 1 in 3 Americans through its 36 Blue Cross companies, intends to release more reports about the cost and quality of care it pays for. Haywood said the reports fit within the country's larger premise of moving toward a payment model that rewards lower-cost care and better outcomes.
“This is in the context of all of us talking about how fee-for-service is not a sustainable model,” he said.
