UTILIZATION AND COST OF ADULT ECHOCARDIOGRAPHY PROCEDURES IN ONTARIO: OPPORTUNITIES FOR QUALITY IMPROVEMENT

Abstract

The Cardiac Care Network of Ontario (CCN) is dedicated to improving the quality, efficiency, access and equity in the delivery of adult cardiovascular services in Ontario. In 2012, CCN published Standards for Provision of Echocardiography in Ontario in an effort to standardize echocardiography services in the province. In 2013, CCN launched the Echocardiography Quality Improvement (EQI) program - a voluntary program to help echocardiography facilities achieve the Standards. Fundamental to CCN’s work is to understand the current state of echocardiography in Ontario, including utilization and cost of services. Utilization data based on Ontario Health Insurance Program (OHIP) echocardiography fee codes for patients 20 years and older from the Medical Services Database was used to determine age and sex standardized rates of echocardiography procedures as well as rates of repeat echocardiography procedures. Additionally, the physician specialties billing echocardiography procedures were analyzed. Using the same OHIP echocardiography fee codes, the Claims History Database was used to determine the total annual cost of echocardiography procedures in Ontario for seven fiscal years (2007/08 to 2013/14). Total number of echocardiograms increased by approximately 150% from 2001 to 2013. Age and sex standardized rates almost doubled between 2001 and 2013, and the rates of repeat echocardiograms between 2006 and 2013 increased by approximately two-thirds. Billing data showed that echocardiography services in FY 2007/08 cost $133M which increased by 38% to $183M in FY 2013/2014. The majority of echocardiograms were performed by cardiologists, followed by internists, diagnostic radiologists and general and family practitioners. The data demonstrate that echocardiography utilization and cost have increased steadily in Ontario over the past several years. Efforts must be undertaken to ensure that echocardiography services in Ontario achieve the established standards. CCN’s EQI program focuses on ongoing quality improvement strategies to ensure appropriate patient selection for the echocardiographic exam, with the appropriate skills and training to ensure technical accuracy in image acquisition and clinical quality in reporting.