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 patie nts treated by HMO and non-HMO cardiologists, we examined a randomly select ed group of 99 patients treated by HMO cardiologists and a randomly selecte d group of 99 patients treated by non-HMO cardiologists. All patients were treated at the Cleveland Clinic. HMO and non-HMO cardiologists treated pati ents with similar age and sex distributions. However, HMO cardiologists wer e more likely to treat emergencies, while non-HMO cardiologists were more l ikely to treat patients with a history of PTCA or CABG. Non-HMO cardiologis ts were more likely to perform multilesion and multivessel procedures. The use of directional atherectomy, stents, and balloon pumps was similar in th e two groups,, but non-HMO cardiologists used rotational and laser atherect omy more frequently. Median cardiac catheterization laboratory costs were 2 0% lower among patients treated by HMO cardiologists, but total hospital co sts were not significantly different for HMO and non-HMO patient groups. Th us, patient populations and practice patterns for HMO and non-HMO cardiolog ists practicing in the same hospital differed markedly, but these differenc es were associated with only modest differences in cardiac catheterization laboratory costs and no differences in total hospital costs.