Cost of Care Healthcare Industry 

High rates of California heart procedures raise cost, health quality concerns

Partner: 
Bakersfield Californian
Fresno Bee
San Francisco Chronicle
Summary: 

Residents in the Northern California town of Clearlake have been having two common heart procedures at five and six times the state average. Rates are also high across a wide swath of the Central Valley. These elevated numbers are partly a result of widespread health problems that show up in the population. But a new study suggests that the high rates go well beyond that, and researchers say the biggest cause may be clinical practice decisions made by doctors. The findings could have enormous implications for health costs and the quality of care. Insurers and government agencies are taking up the cause, increasingly using these so-called variation studies to pressure doctors to change their practices.

Impact Summary: 

Residents in the Northern California town of Clearlake have been having two common heart procedures at five and six times the state average. Rates are also high across a wide swath of the Central Valley. These elevated numbers are partly a result of widespread health problems that show up in the population. But a new study suggests that the high rates go well beyond that, and researchers say the biggest cause may be clinical practice decisions made by doctors. The findings could have enormous implications for health costs and the quality of care.

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Town’s high heart procedure rates raise questions on treatment, costs
Emily Bazar, CHCF Center for Health Reporting | September 4, 2011
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.
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Statewide Angioplasty Rates
Staff | September 4, 2011
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Statewide Angiography Rates
Staff | September 4, 2011
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A consumer’s guide to heart procedures
Emily Bazar, CHCF Center for Health Reporting | September 4, 2011
Q: What is coronary angiography?  Coronary angiography is an X-ray exam of the heart arteries done during a cardiac catheterization procedure that can help doctors see blockages. Doctors insert a catheter (a thin, hollow tube) into an artery, typically in the groin area, and snake it up to the arteries supplying the heart, where they inject a dye visible by X-ray. The pictures they take of the heart arteries are called angiograms. Q: What is coronary angioplasty?
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Variation Report: Advisory Committee
Campaign for Effective Patient Care | September 4, 2011
Lance Lang, MD, FAAFPChair, Advisory CommitteeConsulting Medical Director, Health DialogClinical Director, California Quality Collaborative Jose A. Arevalo, MD, FAAFPPrimary Care PhysicianSenior Medical DirectorSutter Independent Physicians Wade M. Aubry, MDEndocrinologist, Saint Francis Memorial Hospital in San FranciscoAssociate Clinical Professor of Medicine Philip R. Lee Institute for Health Policy StudiesUniversity of California, San Francisco Clarence H. Braddock III, MD, MPH, FACPGeneral InternistProfessor of MedicineStanford University School of Medicine Bill Chin, MDExecutive Medical DirectorHealthCare Partners, LLC
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Database: Statewide heart surgical procedures
Laurence Baker, PhD | September 4, 2011
Database shows rates of heart surgical procedures for 208 geographical areas in California, called Hospital Service Areas (HSA).  They in turn are part of 24 large geographical areas called Hospital Referral Regions (HRR). To download database in Excel, please click here.
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Laurence Baker’s methodology for data analysis
Emily Bazar, CHCF Center for Health Reporting | September 4, 2011
For this study, Stanford Professor Laurence Baker analyzed five years of statewide hospital (and some outpatient) discharge data from the Office of Statewide Health Planning and Development. He focused on three elective medical procedures related to the heart: angioplasty (also called PCI), angiography and coronary artery bypass graft surgery. The data, representing 2005 through 2009, are tied to patient ZIP codes and reflect where the patients lived, not where they received care. Data from federal facilities, such as VA hospitals, are not included.
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About this project
Center Staff | September 4, 2011
This project is a partnership between The San Francisco Chronicle and the California HealthCare Foundation Center for Health Reporting. The center is funded by the nonpartisan California HealthCare Foundation. The study of medical procedures and geographical variation was conducted by Dr. Laurence Baker of Stanford University and was also funded by the California HealthCare Foundation. The work was commissioned by the Campaign for Effective Patient Care, an interest group that promoted the involvement of patients in making medical decisions. Formed during the health reform debate, the group recently disbanded.
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Graphics: High rates of California heart procedures
Staff | September 4, 2011
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Technical Report: Methodology for Heart Procedures
Laurence Baker, PhD | September 4, 2011
Technical Report: Measure development for the Campaign for Effective Patient Care using patient discharge data Laurence Baker, Ph.D.[1]
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S.F. experiment aims to improve medical treatment, lower costs
Emily Bazar, CHCF Center for Health Reporting | September 5, 2011
Researchers long ago established that certain medical procedures are performed at dramatically different rates from place to place, and that these disparities affect the quality and cost of health care. Now, health insurers, hospitals and government agencies from the Bay Area to Washington, D.C., are getting more aggressive about tackling variation in medical care. The issue will surface in San Francisco with a collaboration that started this summer among Blue Shield of California and some local hospitals and physicians, aimed at better coordination of patient care for about 26,000 public employees.
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Classes help decrease weight-loss surgeries
Emily Bazar, CHCF Center for Health Reporting | September 5, 2011
Doctors and hospitals in the Sacramento region had mixed success in their attempts to rein in medical procedures that were being done at higher rates than the norm. After the first year of the Sacramento collaboration among Blue Shield of California, Catholic Healthcare West and Hill Physicians Medical Group, officials found that knee surgeries did not decline, but invasive hysterectomies did. Weight-loss surgeries fell by 13 percent among the patients who were part of the collaboration, said Tricia Griffin, spokeswoman for Catholic Healthcare West. She credited, in part, a new requirement that patients complete a six-month series of classes, called “My True Body,” before getting the surgery.
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Local patients more likely to get invasive heart procedures
Kellie Schmitt, Bakersfield Californian | September 6, 2011
Imagine this: A 35-year-old woman comes to the doctor for vague chest pain without a clear cause. A doctor puts her on a treadmill, a cheap and easy -- but not very accurate -- test for heart disease. The result comes back "mildly abnormal" but she has no risk factors for heart disease such as high cholesterol or high blood pressure. "It's a dilemma: Do you do an angiogram?" said William Bezdek, a Bakersfield cardiologist. "It's not easy." Cardiologists like Bezdek must weigh the risks of doing an angiography, which involves injecting dye into arteries to illuminate any heart blockages. An alternative would be to monitor the progression while exploring other possible sources of the pain, such as anxiety or heartburn.
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Valley heart procedure rates among highest in California
Barbara Anderson, Fresno Bee | September 6, 2011
People who live between Fresno and Bakersfield are more likely to undergo procedures for clogged arteries than almost any other Californians, according to a new study. Between 2005 and 2009, the central San Joaquin Valley had among the highest rates for elective angiography, a diagnostic procedure to find blocked coronary arteries, and for angioplasty, a procedure often involving stents to open them. Rates for angiography – 949 per 100,000 in the Fresno region and 979 in Bakersfield – were 21/2 times the state average of 381 per 100,000. For angioplasty, Fresno's rate of 154 was 11/2 times the state average of 103. Bakersfield's rate of 225 was more than twice the state average.
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BLOG: Series on variation sparks intense, varied response
Emily Bazar, CHCF Center for Health Reporting | September 8, 2011
This weekend, we launched a series in The San Francisco Chronicle about variation in medical care. Variation occurs when certain medical procedures are performed at dramatically different rates from place to place, which affects the quality and cost of health care. When I started reporting, I knew that variation was a growing concern in the healthcare policy world, and that there are increased efforts to rein it in, both to lower costs and reduce potential medical complications for patients. What I didn’t realize was just how much.
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BLOG: Elective angioplasty: When is it appropriate?
Emily Bazar, CHCF Center for Health Reporting | September 9, 2011
When I started doing the reporting for our recently published series about Californians undergoing heart procedures at wildly different rates, depending on where they live, I discovered quickly that the use of elective angioplasty is still hotly debated in the medical world. That’s because some experts believe it’s an overused – and often ineffective – way of treating stable coronary artery disease. Angioplasty is a cardiac catheterization procedure intended to open blocked arteries that supply blood to the heart, usually with stents.
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Reporter Emily Bazar Featured on Capital Public Radio
Center Staff | September 14, 2011
Senior Writer Emily Bazar appeared on Capital Public Radio's Insight program today to discuss her in-depth report on high rates of heart procedures in certain California communities. Bazar published her two-part series in the San Francisco Chronicle. She found that the town of Clearlake, for example, posted rates five to six times the state average for elective angioplasty and angiography between 2005 and 2009.
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Reporter Emily Bazar featured on Valley Public Radio
Center Staff | September 20, 2011
Emily Bazar on Valley Public Radio by CAHealthReport
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Impact of 'high rates of heart procedures'
Emily Bazar | April 16, 2012
More than 100 people commented on this story on the San Francisco Chronicle's website, and some of them added their own experience of seeing abnormally high procedure rates.  One of them, Chuck Magner, told of the death of his father as a result of a surgery he thinks was not needed.  His story became the centerpriece of a future story by the center on carotid stroke surgery at St. Helena Hospital.
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