Unnecessary Angiograms Are Very Costly to Your Health Plan

Recent study released in the New England Journal of Medicine shows that 62% of 400,000 patients that had no known heart disease and were not receiving emergency heart care had no significant heart blockage found in their angiogram results. The study suggests that physicians should do a better job of identifying those patients that need an angiogram, especially for the 20-30% of the patients that have no symptoms.

Medicare pays about $1,400 for an outpatient angiogram and $3,000 for an inpatient angiogram. Private payors typically pay more. So performing angiograms on patients that do not have significant heart blockage is very costly to you as an employer. For these 62% of the patients, payments could be an estimated $446 million (note: estimated by MBGH. Although the test may have not shown any significant blockage, it may still have been appropriate for some of these patients)

So, what can you do about this?

• Encourage your employees to discuss less invasive alternatives, and the risks associted with these as well as angiograms, with their physician.
• Check with your health plan to see what type of decision support tools they are offering your employees and how they let your employees know these tools are available. Also ask them how many employees actually use these tools.
• Consider plan design triggers that require accessing decision support services for non-emergencies through the plan prior to scheduling invasive tests.

Click here to read the Yahoo article which includes a link to the New England Journal of Medicine.