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Spending on Vascular Care Has Little Effect on Amputations

Cheryl Clark, for HealthLeaders Media, November 21, 2013

But the researchers could not explain why, for example, there was a nearly four-fold difference between total cost of overall inpatient care in Salinas CA, $42,613, and Bismarck, ND, $11,077, but not a corresponding difference in amputations.

In fact, according to the analysis, higher spending "was not associated with lower regional amputation rates." The study is published in the Nov. 20 issue of JAMA Surgery.

The researchers analyzed regional variation through administrative claims for 18,463 Medicare beneficiaries who underwent a disease-related amputation between 2003 and 2010, and tracked healthcare spending by amount and type.

Asked why there is such a big difference, Goodney hypothesized that "some areas of the country are able to deliver vascular care in a pretty cost-effective manner. They stick to straightforward operations or interventional procedures, like plain old angioplasty," to open occlusions in the leg that block circulation.

"But there are places that very commonly use more expensive technology, like multiple atherectomy catheters" to remove plaque instead of pushing it against the artery wall, "or laser catheters, or whatever the newest and fanciest device that tends to come down the road. And they use a lot of them."

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