High rates of California heart procedures raise cost, health quality concerns
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.
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.
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.
The Center partnered with the San Francisco Chronicle on this project.
Q: What is coronary angiography?
A: 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.
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 California HealthCare Foundation plans to release findings associated with this measure development effort for the following procedures: angiography, percutaneous coronary intervention (PCI), coronary artery bypass graft surgery (CABG), carotid endarterectomy, hip replacement, knee replacement, cholecystectomy, induction of child birth, cesarean section, vaginal birth after delivery (VBAC), hysterectomy, mastectomy and weight loss surgery.
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.
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.
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."
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.
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 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.
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. Listen here.
Senior Writer Emily Bazar appeared on Valley Public Radio's Valley Edition program today to discuss her report on high rates of heart procedures in certain California communities. Listen here.
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