The federal review of HCA is putting the general problem of unnecessary heart procedures in the spotlight. The AP writes that 700,000 angioplasties, heart opening procedures, are done per year. Almost half of these are elected, performed on patients with stable chest pain. Many doctors use such procedures to treat pain and provide quick relief, although medicine has been cited as a safer and cheaper alternative for patients whose heart disease isn’t life-threatening. The average cost of an angioplasty is $20,000 and typically an overnight stay in the hospital, while prescribed medicine can take a few months to relieve pain but only costs hundreds of dollars per year instead of thousands.
According to Dr. William Weintraub, chief cardiologist at Christiana Care Health System, 8% of non-emergency angioplasties are done inappropriately on patients who should be getting drug treatment alone. Although the decision to perform angioplasties and stents on patients isn’t always clear cut, Weintrub states that performing procedures on patients without artery blockages is “clear-cut fraud, [and] criminal.”
Interventional cardiology procedures as implantation of metal stents or balloons to open clogged arteries and testing for heart disorders are among the biggest revenue sources for HCA. But HCA hospitals aren’t the only ones profiting from such procedures, doctors in general stand to profit from medical procedures as well. The current payment system for physicians also provides incentive for doctors to perform medical procedures. This system reimburses doctors for the procedures and tests they do. According to Dr. Steven Nissen, a Cleveland Clinic cardiologist, “the more procedures they do, the more they get paid… Across the board, Americans undergo more procedures than other people.”
National health care costs, a hot topic in the political realm during this election season, could be cut by $3 billion each year under scenarios such as limiting angioplasties to patients who don’t respond to medication, says Dr. Sanjay Kaul, a cardiologist at Cedars-Sinai Heart Institute in LA. Dr. Jeffrey Marshall, President of the Society for Cardiovascular Angiography & Intervention (SCAI) suggests mandatory cath lab accreditation as a solution the specialty needs to fix the problem of unnecessary stenting on patients without signs of artery blockage. This solution could also contribute to scenarios that cut healthcare costs.
According to Thomas Gallucci, Lazard Capital markets analyst, this problem more broadly reflects issues throughout the industry. Bloomberg reports that the US attorney’s HCA request is part of a heightened government push against alleged health care fraud. In the past month Johnson & Johnson, GlaxoSmithKline Plc, and Teva Pharmaceuticals all announced actions by the US. On July 5th, Glaxo pleaded guilty to illegally promoting drugs in a $3 billion deal with the Justice Department.