Comparison of percutaneous coronary revascularization costs among HMO and non-HMO cardiologists practicing in the same institution

To compare the costs of percutaneous coronary revascularization among patients treated by HMO and non-HMO cardiologists, we examined a randomly selected group of 99 patients treated by HMO cardiologists and a randomly selected group of 99 patients treated by non-HMO cardiologists. All patients were treated at the Cleveland Clinic. HMO and non-HMO cardiologists treated patients with similar age and sex distributions. However, HMO cardiologists were more likely to treat emergencies, while non-HMO cardiologists were more likely to treat patients with a history of PTCA or CABG. Non-HMO cardiologists were more likely to perform multilesion and multivessel procedures. The use of directional atherectomy, stents, and balloon pumps was similar in the two groups,, but non-HMO cardiologists used rotational and laser atherectomy more frequently. Median cardiac catheterization laboratory costs were 20% lower among patients treated by HMO cardiologists, but total hospital costs were not significantly different for HMO and non-HMO patient groups. Thus, patient populations and practice patterns for HMO and non-HMO cardiologists practicing in the same hospital differed markedly, but these differences were associated with only modest differences in cardiac catheterization laboratory costs and no differences in total hospital costs.