The old adage that “built capacity gets used” applies to cardiology too. A Lown Institute study found that regions with the most PCI-performing physicians lead to a disproportionately higher share of patients receiving stents they’re unlikely to benefit from.
- PCI is lifesaving in ACS but leads to lower-value outcomes in stable CAD.
- Specifically, trials like COURAGE and ORBITA suggest it doesn’t reduce mortality versus medication.
- What makes this Lown study interesting is the disproportionate part, since the analysis is among the first to show that physician supply drives low-value care specifically.
So how does provider density correlate with overuse? Researchers analyzed 100% of Medicare fee-for-service and Medicare Advantage data from 2019–2021, to find the share of a hospital’s PCIs performed on patients with stable CAD.
They then stratified the results from the lowest- to highest-supply regions, finding PCI overuse climbed as interventional cardiologist density increased.
- Total PCIs doubled from 15.1 to 31.3 per 1,000 Medicare beneficiaries.
- Low-value PCIs climbed from 2.6 to 7.9 per 1,000.
- Each additional PCI provider per region was associated with ~225 extra procedures.
- Provider supply explained about 90% of regional variance in total PCI use.
In other words, the idea that expanding provider supply lowers costs through competition looks shaky in light of this data.
Here’s the kicker, it’s a structural problem. Market incentives push hospitals to open interventional cardiac programs near competitors that already offer them, multiplying capacity without actually expanding access.
As robust as the analysis is, the study’s limits are worth stating plainly. This is observational data and can’t prove causation.
- Claims-based measures can’t capture patient details like coronary anatomy or prior interventions, and these are Medicare beneficiaries, not all patients in a system.
- Thus, the label of “lower-value” applies to the population level, rather than to individual patients.
The Takeaway
More interventionists, more problems, am I right? But in all seriousness, the data from this Lown study points to a reality of the American health system – when profit drives procedural volume, care capacity doesn’t lead to better outcomes, just more lucrative ones.
