Introduction

We wish to figure out the most common heart procedure in the U.S using the Medicare Physician and Other Supplier Data for years (2012-2016) and then calculate the average cost of this procedure for each state over our five-year time period.

Methods

We extract the following columns for each year (2012-2016) using dplyr:

  • HCPCS_CODE: Code for the specific medical service
  • HCPCS_DESCRIPTION: Description of the HCPCS code for the specific medical service
    • We will search in the description for all heart procedures
  • NPPES_PROVIDER_STATE: The state where the provider is located
  • LINE_SRVC_CNT: Number of Services
    • We will extract the heart procedure with the most number of services
  • AVERAGE_MEDICARE_PAYMENT_AMT: Average Medicare Payment amount for service

Results

First we find the top Heart Procedures in the U.S, which are listed below. We determine that Ultrasound Examination of Heart is the most common heart procedure in the U.S.

Table 1. Top 5 Heart Procedures in the U.S
Total Services Description
7,372,122 Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function
2,014,452 Nuclear medicine study of vessels of heart using drugs or exercise multiple studies
1,326,899 Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the
1,286,032 Exercise or drug-induced heart and blood vessel stress test with EKG monitoring, physician interpretation and report
1,103,276 Exercise or drug-induced heart and blood vessel stress test with EKG monitoring and physician supervision

Next, we compute the average cost of this procedure for each U.S state from (2012-2016). For brevity, we will display the top five states with the highest average cost over the 5-year period. Likewise, we will display the five states with the lowest average cost of this time period.

Table 1. Average annual Heart Ultra Sound Cost
State 2012 2013 2014 2015 2016 Overall Average
WI $1,103.32 $1,160.30 $ 67.63 $ 66.80 $ 66.23 $492.86
AK $ 979.98 $ 989.20 $117.44 $115.43 $125.93 $465.60
WY $ 884.05 $ 861.17 $ 86.67 $ 94.22 $ 89.30 $403.08
VI $ 662.89 $ 703.30 $102.46 $106.96 $100.61 $335.24
DE $ 644.48 $ 623.43 $100.44 $101.99 $102.41 $314.55
ID $ 243.25 $ 244.17 $ 58.92 $ 59.51 $ 59.40 $133.05
PR $ 194.20 $ 190.50 $ 92.60 $ 94.90 $ 92.97 $133.03
NE $ 242.87 $ 235.49 $ 60.85 $ 61.84 $ 61.95 $132.60
ME $ 286.23 $ 212.36 $ 52.39 $ 51.12 $ 50.89 $130.60
SD $ 229.12 $ 245.41 $ 50.32 $ 50.82 $ 49.01 $124.94

In order to visualize the trends in our time-series we will display the results graphically.

## Warning: Detecting old grouped_df format, replacing `vars` attribute by `groups`
**Figure 1.** Average annual Cost of Heart Ultra Sound, Top 5 and Lowest 5 U.S States

Figure 1. Average annual Cost of Heart Ultra Sound, Top 5 and Lowest 5 U.S States

Discussion

First, we find that Ultra Sounds of the Heart are the most commonly used heart procedure in the U.S. Second, the average cost of an ultra sound decreased dramatically for all states in 2014. This trend can be further evidenced by the establishment of the Affordable Care Act (ACA) whose major provisions came into force in 2014.