Tuesday, August 7, 2012

When profit trumps the Hippocratic Oath

The New York Times has an interesting article concerning unnecessary cardiac procedures allegedly carried out at a national chain of hospitals at its Florida facilities.  Here's a brief excerpt.

HCA, the largest for-profit hospital chain in the United States with 163 facilities, had uncovered evidence as far back as 2002 and as recently as late 2010 showing that some cardiologists at several of its hospitals in Florida were unable to justify many of the procedures they were performing ... In some cases, the doctors made misleading statements in medical records that made it appear the procedures were necessary, according to internal reports.

Questions about the necessity of medical procedures — especially in the realm of cardiology — are not uncommon. None of the internal documents reviewed calculate just how many such procedures there were or how many patients might have died or been injured as a result. But the documents suggest that the problems at HCA went beyond a rogue doctor or two.

. . .

In a recent statement, HCA declined to provide evidence that it had alerted Medicare, state Medicaid or private insurers of its findings, or reimbursed them for any of the procedures that the company later deemed unnecessary, as required by law.

“When the company becomes aware of a situation in which we might have a reimbursement obligation, we assess, with outside resources, what our reimbursement obligations might be,” the statement said.

HCA also declined to show that it had ever notified patients, who might have been entitled to compensation from the hospital for any harm.

. . .

C. T. Tomlinson [a nurse] said he could not believe his eyes as Dr. Abdul Shadani prepared to insert a stent in a heart patient in the cardiac catheterization lab of HCA’s Lawnwood hospital in the late spring of 2008.

Mr. Tomlinson, a traveling nurse who had worked at more than a dozen cath labs before arriving at Lawnwood, said in a telephone interview that he saw no blockages in the images of the patient’s artery.

“Sir, what are we going to fix?” Mr. Tomlinson recalled asking Dr. Shadani. The doctor responded by asking the nurse if he did not see the 90 percent blockage in the artery. Mr. Tomlinson did not, and looked at the others in the room. They all shrugged, he said, and Dr. Shadani inserted the stent.

Mr. Tomlinson reported his concerns to hospital officials. Shortly after, he was told his contract would not be renewed. An internal memo, however, concluded that Mr. Tomlinson had been retaliated against.

. . .

Cardiology is a lucrative business for HCA, and the profits from testing and performing heart surgeries played a critical role in the company’s bottom line in recent years.

Some of HCA’s busiest Florida hospitals perform thousands of stent procedures each year. Medicare reimburses hospitals about $10,000 for a cardiac stent and about $3,000 for a diagnostic catheterization.

There's more at the link.

I highly recommend reading the whole article.  I'm convinced that this problem extends far beyond the few Florida facilities identified in the report - in fact, I'm willing to bet it may be found in every state in the Union.



Mad Jack said...

I used to work in the medical transcription industry and I can tell you beyond the shadow of a doubt that this problem has existed for years. Insurance companies are motivated by collecting premiums and denying claims. The medical industry is motivated by money, and they know that money comes from the insurance company - not the patient. Getting paid big bucks for a procedure generally means doing a little extra work, whether the work is needed or not.

If the patient had to pay for their own treatment, none of this would be happening.

Shrimp said...

A hundred thousand +1's for Mad Jack. And then another few thousand more.

Insurance fraud isn't just when the customer tries to lie and collect money from the insurance company. When the doctors are putting things in there because they know the insurance company will pay it, that's defrauding the insurance company. When the doctor takes seven X-rays of a broken femur, because that's what the patient's insurance company will allow, rather than taking the minimum necessary amount, that's insurance fraud.

And who pays for it? Initially, the company does, but in the end, as with every consumer transaction, we the consumers pay for it. Higher prices, higher premiums, fewer people choosing coverage (because the premiums are too high), more people coming to the emergency room for their "healthcare" because they have no coverage and the prices of the medical work are outrageous.

I know, let's pass a law requiring people to have coverage. There, it's fixed. Don't you feel better now?

trailbee said...

We have gone from nose jobs to heart stents. We are nothing if not creative.
I wonder if insurance fraud will EVER be erased. That's like denying lobbyists entrance onto the beltway. Won't happen. How depressing.