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Inside Cardiology's PCI Problem

Cheryl Clark, for HealthLeaders Media, August 18, 2011

"The most important point of our paper, the biggest take home message...is the substantial variability between hospitals in these elective cases in terms of the degree of inappropriateness," Ralph Brindis, MD, past president of the American College of Cardiology and an author of that JAMA report, told me in an interview last week.

"Feeding back this data will help hospitals and clinicians re-examine their practice patterns, so we can try to eliminate angioplasty where there is no value," he said.


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Other evidence that PCIs are being inappropriately performed comes in a gaggle of recent highly publicized state and federal complaints that specific doctors bilked federal and private payers millions of dollars for unnecessary stent and other angiography procedures.

In just the last few months at least seven doctors in Tennessee, Maryland, Pennsylvania, Texas, and Louisiana faced penalties and accusations for performing unnecessary cardiovascular procedures in hundreds of patients.

For example, one patient received 32 stents and another 25, far above the average rate of a mere 1.6 per patient.  A few hospitals now being targeted, may have known about such schemes but failed to stop them.

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1 comments on "Inside Cardiology's PCI Problem"


Will ElLaissi (8/19/2011 at 2:59 PM)
First, I must say that your article is great. It shed insight on the implications of over-stenting and the complications that can arise. Recently, it was reported, I believe in the NEJM, that PCIs could be performed in an out-patient setting due to the competence of invasive cardiologists (meaning that there is now little threat that an artery could burst producing a need for emergency open heart surgery). I work in the industry and I do feel torn by one issue that you raised. You mentioned that some hospitals hang their hat on their cardiology program and the margins that they receive from angioplasties, CABGs, or Valve replacements. We are certainly in this industry to help the patient, but a disconnect appears when we discuss ways to correctly incentivize physicians AND hospitals to cut down on the "inappropriate" PCI cases. It is a hard sell as a consultant or a policy maker to pitch quality when many hospitals suffer for higher quality (Of course we do, but you address the problems that arise). I guess this is the catch in our healthcare system. We are all in healthcare to improve it and to seek options that would improve the way healthcare is delivered to the patient, but practically speaking, we see the downside of doing the right thing. The hope I am sure is that ACOs and bundled payments will help correctly incentivize hospitals and physicians towards higher quality outcomes at lower costs. However, practically speaking, for hospitals that enjoy the lucrative nature of high margin procedures which allow them to stay "in the black" or not deep in the red, can they afford higher quality of care? Will shared savings correctly create the needed incentives? Because as I mentioned, there is no doubt that everyone has picked this industry to create the best care for the patient.