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HCA Cardiac Treatments: Unnecessary and Expensive

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HCA, Hospital Corporation of America, is the country’s largest for-profit hospital chain, with 163 facilities nationwide. Earlier this week, we learned that the chain is confronting mounting evidence that cardiologists at many of its Florida hospitals have been routinely performing unnecessary cardiac procedures for years. Such procedures include performing angioplasties on and inserting stents into patients without arterial blockages—something that Dr. William Weintraub, cardiology chief at Christiana Care Health System in Newark, Delaware has called “clear-cut fraud” and “criminal.”

Such procedures carry serious risks, not limited to scenarios like the following, which occurred at HCA hospitals:

At Bayonet Point, a 44-year-old man who arrived at the emergency room complaining of chest pain suffered a punctured blood vessel and a near-fatal irregular heartbeat after a doctor performed a procedure that an outside expert later suggested might have been unnecessary, documents show. The man had to be revived. “They shocked him twice and got him back,” according to the testimony of Dr. Aaron Kugelmass in a medical hearing on the case.

In another incident, an outside expert described how a woman with no significant heart disease went into cardiac arrest after a vessel was cut when a Bayonet Point cardiologist inserted a stent, a meshlike device that opens coronary arteries. She remained hospitalized for several days, according to a person who has reviewed internal reports. -NYTimes

But why would doctors subject their patients to these kinds of risks if the procedures they had ordered were unnecessary?

A payment system that reimburses doctors for the number of tests and procedures they do is part of the problem, said Dr. Steven Nissen, a Cleveland Clinic cardiologist. ‘‘The more procedures they do, the more they are paid. That system creates incentives do to medical procedures, whether it’s a CT scan, or a stent, or a knee replacement. Across the board, Americans undergo more procedures than other people.’’ –boston.com

Cardiac procedures play a huge role in HCA’s inordinate profits every year. Medicare reimburses hospitals about $10,000 per cardiac stent, and that’s no doubt a fraction of what most insurance companies reimburse.

As long as we have a health care system that rewards doctors for performing procedures the same way companies reward salesmen for pushing product, we are going to run into this problem again and again. But that doesn’t excuse the doctors who decide to get greedy and unnecessarily put people’s lives at risk to make greater profits.