If you're a Medicare beneficiary living in Oklahoma City, you're about two times more likely to undergo balloon angioplasty than a Medicare beneficiary living in Tyler, Texas, according to a recent report.
Typically, doctors perform this procedure for patients with some heart conditions — and a report released this week shows that the rate at which it's performed varies widely across Oklahoma, Texas, Arkansas and Louisiana.
The report, from the Dartmouth Atlas Project, analyzes care provided in regions across the U.S. and focuses on trends in elective, or “preference-sensitive,” procedures.
When a treatment is elective, it means there is more than one way to treat the patient's illness or condition, and each possible treatment involves different trade-offs that individual patients will view of varying levels of importance, the report states.
Using Medicare data, the Dartmouth Atlas Project has documented variations in how medical resources are distributed and used in the U.S. for the past 20 years.
82 cities examined
The report released this week provides the rate of a variety of procedures performed in about 82 Oklahoma cities.
Oklahoma City was one of the cities specifically called out in the report for its rate of balloon angioplasty, also called percutaneous coronary intervention, or PCI. The procedure is used to open clogged heart arteries, according to the Mayo Clinic.
Oklahoma ranked second highest in heart disease death rates in the U.S. in 2007, according to the state Health Department. Heart disease is the leading cause of death in Oklahoma and the U.S.
Some might argue that the high rate of balloon angioplasty is because Oklahoma's heart disease problem.
Not Shannon Brownlee.
Brownlee, one of the authors of the Dartmouth study, said balloon angioplasty is often performed on questionably appropriate patients who often don't know what the actual benefits from the procedure will be.
The national average of balloon angioplasty, or percutaneous coronary intervention, is 8.2 procedures per 1,000 Medicare beneficiaries, according to the report.
In Oklahoma, it's 12.5 procedures per 1,000 Medicare beneficiaries, according to the report's three-year analysis of Medicare data.
“Either you've got one hell of a heart disease problem, or you have practices in Oklahoma City that are more aggressive, and they're more likely to recommend this procedure,” she said.
The procedure is one of the most profitable that a hospital can offer, and sometimes, it can be a hospital's entire profit margin, Brownlee said.
The procedure has proved effective in the middle of a heart attack — getting a balloon angioplasty or stent can reduce your chance of dying over getting clot-busting drugs, Brownlee said.
But research has shown that, of an estimated 2 million people who got the procedure about five years ago, about 800,000 procedures were performed because of a heart attack, Brownlee said.
1.2 million elective
The other 1.2 million people got the procedure electively, Brownlee said.
“You can be an appropriate candidate for this procedure and still choose not to do the procedure because it is elective,” Brownlee said. “It's not like you're going to die if you don't do PCI, and in fact, it's very likely that the drugs and medical management will control your chest pain about as well as PCI will in many cases.”
Dr. John Harvey, Oklahoma Heart Hospital CEO, has found that even after he explains to patients what percutaneous coronary intervention will and won't do for them, they still prefer the more aggressive treatment, even when he tells them that the stent won't keep them from having a heart attack
“It's important that we as physicians explain there isn't a difference in mortality,” Harvey said. “There is value to balloon angioplasty or stent procedures, but you need to explain what the value is.”
Harvey said physicians could do a better job of policing themselves, tracking what their utilization rates and comparing that to the national average. And overall, physicians must do a better job of explaining the value versus the risk of a procedure, Harvey said.
“I'm certain there are some physicians who don't do an adequate job of explaining the options to patients,” Harvey said.