Coronary artery blockade resulting in chest pain is known as angina, which is treated with placement of stent in selected cases. In the past only balloon angioplasty were tried and resulted in symptom relief. In these cases, after few weeks the coronary arteries were found to be narrowed again. So to keep lumen wide open the researcher invented procedure such placement of stent within the coronary artery. Stent placement is less invasive and recovery is faster when compared to coronary bypass open heart surgery. The cost of stent placement is less than open heart surgery. One in 5 individuals die every year in USA because of complications caused by coronary artery diseases. Published data suggests stent placement is the most effective treatment for coronary artery disease. The alternative treatment to placement of coronary artery stent is cardiac bypass surgery. Coronary stents are small sizes of metallic tubes, which provide support to the weakened arteries. Indeed, the question that may strike in the mind of every common person is that why the placement of coronary stents and other related procedures are costing so high in hospitals and clinics.
The Stent Placement Procedure Involves Following Steps Which Directly Results in Increasing the Cost of Stent Procedure
Cost of Nursing Care and Physician Services
Every stent placement procedure is preceded by the detailed history taking and clinical examination prior to procedure, which involves several nurses and specialist like cardiologist. The facility fee where stent placement procedure is done covers most of these expenses except fees of specialist like cardiologist and radiologist.
Cost of Stent Placement Procedure in High Quality Fully Equipped Facilities
The stent placement procedure is performed in high quality fully equipped out-patient cardiac facility. The most facilities are equipped with most advanced cardiac and X-Ray equipment. The special equipments are operated by highly qualified technicians, engineers and nurses. The results are analyzed by on site interventional cardiologists, cardiac surgeon and radiologist. The cost of special high quality dyes and catheters are included in facility charges. Several types of disposable expensive sterilized catheters and wires are used during the stent placement procedure. The cost of balloon catheter and multiple stent is bundled into facility charges. Facility fees are variable depending on reputation of the facility, quality service provided and equipment used. The facility charges also include medications, medical supplies, necessary nursing care, usage of equipment, nutrition, meals and other essential medical services.
Cost of Physician Fees
The stent placement procedure is performed by invasive cardiologist and results are interpreted by same cardiologist and cardiac surgeon. In few cases second opinion is taken from radiologist for radiological studies. The fee schedule for specialist performing stent placement depends on time and experience. The physician fee schedule is published by Medicare, private insurance provider and medicaid every year. Most physicians accept the amount published in annual fee schedule. Though, patients have to pay out of pocket expenses such as deductible and co-pays. Most physician avoid participation with Medicaid, which is state owned insurance provider. Few physicians do not participate in any insurance provider, in such cases individual can negotiate the cost of physician fees with physician office. Almost all physician service fees are billed 2 to 4 times Medicare published schedule amount.
Balloon Angioplasty Procedure Results in Higher Cost of Procedure
Placement of cardiac stent is an invasive procedure and needs outpatient surgical facility also known as outpatient cardiac procedure facility. Prior to placement of stent, most patients are treated with placement of balloon catheter. The balloon catheter is passed into coronary artery through the artery in groin. The placement of catheter in narrowed coronary artery is preceded by dye injection. Dye study provides the information of anatomical site of narrowed coronary artery. Next the balloon segment of the catheter is positioned within the narrowed coronary artery. The balloon is then carefully inflated to widen the lumen. The procedure is known as balloon angioplasty. The procedure is tedious and often need more than one balloon catheter resulting in increased cost of procedure. Balloon angioplasty is often repeated after few months or may need follow up stent placement after few weeks.
Types of Coronary Stents Used Determines Higher Cost
Following balloon angioplasty stent is inserted through the catheter and placed within the narrowed segment. Stent is a small mesh tube, which expands within weak and blocked coronary artery. The properly placed stent opens up the blocked coronary blood vessels. There are two main types of stent material. The first family of stent were Bare Metal Stents (BMS). Further research and published data suggested better results are possible with advanced type of stent known as Drug Eluting Stents (DES). The DES stent are more expensive than BMS stent. The combination of DES stent and clot preventing medicine had reduced the risk of narrowing and thrombosis of coronary artery significantly. The newer self-expanding stent has replaced balloon angioplasty and shown further improvement in expanding the coronary artery. The cost of self-expanding stent is higher. Though, cost of stent has reduced substantially since 2016. BMS stent price has reduced from $ 1,150 to $ 450 and DES stent prices are reduced from $ 3,200 to lower range of $ 1,000 to $ 750. The published study suggests stent angioplasty cost $ 3,268 more than balloon angioplasty but in long run prevent repeat procedure and cost of repeat procedure.1
How Much Does it Cost Overall to Have a Stent to Put in?
The total cost of stent placement is divided in facility fees and physician fees.
The facility fee of stent placement varies from $ 17,000 to $ 53,000. The median cost found across the USA is $ 21,000.2
The facility fee includes-
- Cost of pre-op evaluation by nurses and primary care physician,
- Monitoring in pre-op room,
- Use of operating room for procedure,
- Intravenous catheter and fluid,
- Cost of simple catheter,
- Cost of balloon angioplasty catheter,
- Cost of stent,
- Cost of several disposable surgical equipment and
- Fees for Lab studies.
The surgical facility fee includes services of nurses, technician, physician assistance and equipment maintenance engineers. The physician fees are not included in facility fee. The cost is higher if patient had balloon angioplasty prior to stent placement. The published study suggests the long term results are better if stent are placed without performing balloon angioplasty prior to placement of stent.3
The procedure may involve 2 or more cardiologists and radiologist. Each physician fee may range between $ 500 to $ 1,500 depending on time taken to finish the procedure and post procedure patient care. Cardiologist, radiologist and surgeons usually charge separately for separate medical/healthcare services.
The billing reports are often confusing because of various billing components. Patients has to look for separate charges involving facility fees, fees for lab studies and doctor’s fees. The billed amount is often much higher than amount paid by the private insurance provider or Medicare. The cost of providing stent placement services may be higher than average in some institution. In few cases institution or hospital may not have any agreement with insurance provider. In that case, individual patient will be liable for entire billed amount for stent placement, which can be substantial. Medicare pays only 80% of the agreed amount and remaining 20% of the amount is paid by either supplemental private insurance provider or patient. The co-pays and deductibles are paid by the patient at the time of discharge. Uninsured patient may negotiate the price of entire procedure though the price is non-negotiable in major known institution. Some uninsured patients may qualify for Medicaid insurance coverage.
- What is a Stent to the Heart?
- Are Heart Stents Permanent?
- How Long Does an Angiogram and Stent Placement Take?
- Are All Stents Metal?
- Why Would You Need A Stent In Your Heart?
- Do Stents Really Work?
- Are Heart Stents Dangerous?
Acute and long-term cost implications of coronary stenting
Eric D Peterson, Patricia A Cowper, Elizabeth R DeLong, James P Zidar, Richard S Stack and Daniel B Mark, Journal of the American College of Cardiology, Volume 33, Issue 6, May 1999
Direct coronary stenting versus predilatation followed by stent placement.
Brueck M1, Scheinert D, Wortmann A, Bremer J, von Korn H, Klinghammer L, Kramer W, Flachskampf FA, Daniel WG, Ludwig J., v