Blue Cross teams with 2 CQIs to address costs, improve treatment for peripheral arterial disease

Years ago, when the process of atherectomy was introduced as an option for removing 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.

In 2018, the U.S. Centers for Medicare & Medicaid Services increased reimbursement for atherectomy procedures in order to shift care to the outpatient setting. But while use of atherectomy did increase, the cost savings weren’t realized. Safety and quality outcomes also weren’t 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 situation, Blue Cross is teaming with the BMC2 CQI and the Michigan Value Collaborative 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.

*Blue Cross Blue Shield of Michigan doesn’t own or control this website.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.