Improving vascular care in Michigan: What to do when the simpler option turns out to be less safe, more costly

By: Debbie Reinheimer

Years ago when atherectomy was introduced as an option to remove plaque in the arteries, the hope was that it would be a less costly option because the procedure could be performed in an outpatient setting. In Michigan, other artery-opening methods of balloon and stent angioplasty must be done in a hospital that has an approved open-heart surgery service.

The U.S. Centers for Medicare and Medicaid Services (CMS) in 2008 increased reimbursement for atherectomy procedures in order to shift care to the outpatient setting. But while use of atherectomy did indeed increase, the cost savings were not realized. Safety and quality outcomes also were not better than angioplasty. In fact, one study found that atherectomy was associated with a 38% rate of major adverse events in the limbs and a three times greater increase in long-term amputation.

Through the BMC2 CQI, one of Blue Cross Blue Shield of Michigan’s 17 collaborative quality initiatives, clinicians reviewed the statewide registry of data collected on angioplasty and atherectomy procedures. After analyzing utilization and payment patterns, they found that 10% of the physicians performed 70% of the atherectomies in Michigan and accounted for 85% of the payments.

To address this, Blue Cross is teaming with the BMC2 CQI and the Michigan Value Collaborative (MVC) CQI to develop and analyze new care models and payment models for atherectomy and angioplasty in Michigan. A multidisciplinary group will review data and propose a process of care – called a care pathway – for peripheral arterial disease.

The team also will examine potential changes in reimbursement levels, such as increasing them for angioplasty and reducing them for atherectomy. Analyzing both claims and outcomes data will help determine whether these efforts are working.

“I think this is a great example of the collaboration between our organizations. The Michigan Value Collaborative provides hospital-unique analytic data that can be used to identify opportunities for quality improvement and appropriate cost reduction. This helps ensure hospital and physician leaders are able to enhance the impact of their quality improvement activities,” said Faris Ahmad, M.D., medical director at Blue Cross Blue Shield of Michigan.