Town’s high heart procedure rates raise questions on treatment, costs

Clearlake, Lake County -- This rural Northern California town known for its scenic, bass-filled lake now has another distinction: Clearlake-area residents have been undergoing two common heart procedures more than any other Californians, posting rates so high that they exceed most other regions by multiple factors.

Between 2005 and 2009, people here underwent one of these procedures, elective angioplasty, at 15 times the rate of people in Sonoma, and more than five times the rate of San Franciscans and Californians as a whole. Angioplasty is used to open blocked arteries that supply blood to the heart, usually with stents.

 Database shows rates of heart surgical procedures for 208 geographical areas.

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These results are part of a new analysis of statewide hospital data by Stanford health research and policy Professor Laurence Baker, which shows that the use of certain elective medical procedures varies wildly with geography.

Baker's work builds on a separate variation analysis of Medicare data that reveals something even more striking: In 2005, 2006 and 2007, the three most recent years for which data are available, Clearlake had the highest inpatient angioplasty rate in the country.

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.

Cost of angioplasty

The median charge for one type of 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, a figure that's in line with many Northern California hospitals.

While Clearlake's rates were California's highest, heart procedures occurred with high frequency in the Central Valley as well. Residents in Lindsay (Tulare County) had angioplasty at four times the state average. Corcoran (Kings County) residents had five times the state rate for angiography.

Above-average use also was present in urban centers. The angioplasty rate for residents of La Jolla (San Diego County), for example, was 75 percent above the state norm.

Health providers usually pin disparities like this on the condition of their local populations, saying their patients are unique because they're sicker, more obese, poorer or otherwise more vulnerable than people in other areas. That's the argument of Adventist Health-owned St. Helena Hospital.

"To find this sort of a rural community with this many overlapping health situations, it's kind of like Haiti. You're really dealing with Third World situations here," said Joshua Cowan, Adventist's regional vice president for marketing.