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July 20, 2015

DES MOINES, IA – The cost of angioplasty procedures — 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, according to a report by the Blue Cross Blue Shield Association (BCBSA), the national federation of the 36 independent Blue Cross and Blue Shield (BCBS) health insurance companies.

The report, “A Study of Cost Variation for Percutaneous Coronary Interventions (Angioplasties) in the U.S.External Site,” shows that prices for angioplasty procedures can cost more than five times as much depending on which hospital a patient chooses within a market.

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 quality and cost as they choose the best facility for their care.

The study shows the median cost for angioplasty procedures in Des Moines was $18,355. This is lower than the national median of $27,144 in 86 of the 100 largest markets where claims data was available.* The procedure ranged in price from $15,064 to $22,716 in Des Moines hospitals.

“This study shows the value of providing consumers with data that will better inform their health care decisions,” said Mike Fay, Wellmark’s vice president of health networks. “It also demonstrates that through collaboration with our local hospitals, we have implemented payment methodologies with an annual update tied to the Consumer Price Index to help reduce the rate of increase in health care costs for our members.”

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 health care costs, with expenditures totaling $10 billion in 2014, according to an American Heart Association report titled Heart Disease and Stroke Statistics: 2015 UpdateExternal Site.

“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, Wellmark recognizes local hospitals with its Blue Distinction® Centers+ designation, which recognizes medical centers that demonstrate expertise in delivering patient care safely and effectively and are also 20 percent or more cost-efficient than non-designated facilities. In Iowa, there are nine Blue Distinction® Centers+ for Cardiac Care, including two in Des Moines.  

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 health care affordability and access to care.

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

*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 was unavailable for the states of New York, South Carolina, and Texas, thus they were excluded from this study. Montana, Wyoming, North Dakota, South Dakota, Vermont and Maine did not have any MSAs in the top 100, thus they were excluded from this study.