DMS project discovers excessive surgery rates

by Kelsey Blodget | 8/22/06 5:00am

Dartmouth Medical School researchers are blowing the whistle on inadequate medical care and malpractice across the nation. The Dartmouth Atlas of Healthcare project has garnered national media attention for its study of national, local and regional distribution of medical resources since its inception in 1996, and it recently stirred controversy over the disproportionately high rate of angioplasties performed in an Ohio hospital.

"After a certain point, getting more healthcare [can] lead to worse outcomes," Megan McAndrew, Communications Officer for the Center of the Evaluative Clinical Sciences at Dartmouth, said.

The EMH Regional Center community hospital in Elyria, Ohio, performs almost four times more angioplasties than the national average, which could significantly boost the cardiologists' paychecks. Medicare pays $11,000 for each angioplasty involving a drug-coated stent -- around $800 of which might go into the cardiologist's pocket, according to an Aug. 18 article in The New York Times.

The Atlas project showed that for every 1,000 Medicare patients treated in Elyia, 42 receive an angioplasty -- by far the highest rate in the country.

Lafayette, Calif., has the next highest in the country at 28 angioplasties per 1,000 patients, and one of its doctors is currently under indictment for performing unnecessary heart surgeries, according to McAndrew.

Elliott Fisher, one of the DMS doctors conducting research for the project, said that a belief in the surgery's effectiveness as well as financial incentives might spur cardiologists to perform the surgery so frequently.

Angioplasties are proven to reduce chest pain, but "there is not sufficient data to say that it is safer or more effective in the long run than treating those blockages with medication" or a healthier lifestyle, Fisher said.

McAndrew added that heart surgeries are invariably somewhat dangerous.

"Every time someone has one of these procedures they are exposed to a certain amount of risk [such as] infections, errors, damage to the blood vessels, reaction to medications [and] medication errors."

The EMH Regional Center has invited the Society for Cardiovascular Angiography and Interventions to complete an independent, objective and professional review and evaluation, according to an official statement. The statement claimed that the hospital's success rates are high and complication rates are low.

Fisher pointed out that high surgery success rates can be misleading.

"One can do very well and have good outcomes by operating on lots of people who don't need the procedure," he said. "The question is not whether they're doing a good job, the question is whether they're doing it on the right patients."

EMH Regional is by no means the only hospital receiving extra scrutiny as a result of the Atlas project's findings. The project showed that a hospital in Redding, Calif., owned by Tenet Healthcare was performing "an extraordinary number of coronary bypass surgeries," according to McAndrew. Two of its physicians were accused of performing heart surgeries on hundreds of patients who didn't need them and the federal government sued Tenet for defrauding Medicare. Tenet settled in 2003 for $54 million without admitting wrongdoing, according to the The New York Times article.

Fisher believes it would be beneficial to move towards a system where doctors are rewarded for achieving good health outcomes and high patient satisfaction, rather than "having financial incentives to do more, or do less, on behalf of their patient."

Lowering the costs of procedures to reduce financial incentives has proved ineffective, according to McAndrew, since doctors can receive greater financial gain by merely increasing the number of operations they perform.

"It's not the price of the service, it's the volume," McAndrew said.

"The fear is that the whole system will just have to collapse before anyone can find the will to do anything about [changing] it," she said.

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