Another Possible Contributor to High American Healthcare Costs

[haha]

http://www.nytimes.com/2010/12/06/health/06stent.html?_r=1&src=me&ref=general

 

[Texas Proud]

Some interesting clips from the article....


"concludes that Dr. Midei “may have implanted 585 stents which were medically unnecessary” from 2007 to 2009. Medicare paid $3.8 million of the $6.6 million charged for those procedures"

Which calculates to $11,282 per stent... so they do not seem cheap...


"Dr. Mark Midei, had inserted 30 of the company’s cardiac stents in a single day in August 2008"

OR... billings of over $338K... not bad is it


AND....

"The federal Medicare program spent $3.5 billion last year on stent procedures. "

Say what If the cost is the same... that means over 620,000 stents in one year... paid by Medicare... (using the prior info of them paying 50%) I don't know the total number on medicaire.... so I don't know if this is way out of line or not.. But I think $11K per is a bit high....

 

[Martha]

There has been research that shows the more specialists in a geographic area, the more of visits and revists per capita, but without better outcomes. FAQ - Dartmouth Atlas of Health Care This isn't a fraud issue, unlike the case discussed in the article, but a human nature issue.

But there is some good news too, a drop in reimbursement can cut unnecessary care: Study Shows Drop in Unnecessary Treatment after Medicare Cuts

The issue may be whether it also cuts necessary care. At least in the this study it wasn't shown to be the case.

 

[Moemg]

Having spent forty years in health care I have enough of these type stories to write a bestseller .

 

[Rich_by_the_Bay]

Having spent forty years in health care I have enough of these type stories to write a bestseller .

Yep, I cringe when I hear stories like this. Here in Florida a few years back, a dermatologist was performing waaaay too many skin cancer excisions after determining that the initial biopsy showed cancer cells.

The so-called biopsy specimens turned out to be little pieces of chewing gum, just so his office assistants didn't get too suspicious. In the end it was his assistants who turned him in, IIRC.

 

[dgoldenz]

I always thought it was weird how linked NY Times posts require a log-in, but if you google the title of the story you can read it for free directly on their website....

 

[MichaelB]

The senators solicited 10,000 documents from Abbott and St. Joseph. Their report, provided in advance to The New York Times, concludes that Dr. Midei “may have implanted 585 stents which were medically unnecessary” from 2007 to 2009. Medicare paid $3.8 million of the $6.6 million charged for those procedures.

I wonder how many of the patients did any research or reviewed the recommendations with other medical practitioners before agreeing to the stents.

Sometimes it isn't the Doctor but the patient.

Tara Heglar was picking up her son from his crib when the pain started, a searing sharpness on the side of her right hand.
It began when Charlie was about a month old and continued to worsen over the next half year. The snap of pain would return when she used her iPhone, lifted her son or even cradled his head while he nursed. "It felt like I had bruised my bone," says the 38-year-old Ms. Heglar, a business analyst in Concord, N.C.
An orthopedic surgeon diagnosed Ms. Heglar with mommy thumb, formally known as De Quervain's tendinitis, an inflammation of the tendons below the thumb down to the wrist. Although the condition has been around as long as parents have hoisted their children, doctors say a combination of heavier children, older new mothers, cribs that are lower to the floor and frequent scrolling and typing on smartphones has sent the number of cases skyward.
Orthopedic surgeons estimate that between one-quarter and one-half of new mothers experience symptoms of De Quervain's. When common pain relievers don't ease the inflammation, patients are getting steroid injections, splints and even surgery.

My emphasis. Article here The Baby May Be Giving You Mommy Thumb - WSJ.com
I wonder if it has occurred to anyone to stop texting and just give the thumbs a rest.

 

[Moemg]

I wonder how many of the patients did any research or reviewed the recommendations with other medical practitioners before agreeing to the stents.

.

You are in the Cardiac cath lab having an angiogram after you have had some symptoms of chest pain the Doctor tells you you have a blockage that might kill you and you need stents. How many people in this position do you think say I'll wait on that I want a second opinion ?

 

[ls99]

Maybe the trick is to avoid the cath lab if at all possible. Seems lately lots of invasive pressure monitoring is hyped.

 

[MichaelB]

You are in the Cardiac cath lab having an angiogram after you have had some symptoms of chest pain the Doctor tells you you have a blockage that might kill you and you need stents. How many people in this position do you think say I'll wait on that I want a second opinion ?

I don't doubt that happened, and I also expect Dr. Midei delivered a finely-honed message that made the stent seem all the more imperative. They were not all emergencies, however, and I suspect there are many Doctors that would have given different advice. I know that is easy for me to write, but any remedy to a problem like this has to include individuals being more involved with their health and their healthcare.

 

[GregLee]

I'm very skeptical of these accusations -- there are just too many weasel words in the report. Dr. Midei installed stents which may have been unnecessary. Well, were they unnecessary, and was that known at the time they were installed? What exactly does "unnecessary" mean here? That survival time was not increased at all? Or not increased very much? Or not increased enough, in someone's judgment, to justify the cost of the procedure?

 

[LuvSouth]

Aren't there guidelines that MDs in the States have to follow ? Here in Canada MDs must follow the guidelines and perform procedures only if it is necessary, and submit claims to get paid by the provincial governments eventually.

It seems to me the high health care cost is a typical example of full blown capitalism: The rich become richer ...

No wonder people told me as soon as the hospitals found out Canadians who have top up medical insurance, they treat them like "kings". People told me doctors in the hospitals (in the States, not in Canada) insisted patents stayed longer in the hospitals for observation, and of course more tests needed to be done ...

Some people said the medicare in the States can be fixed right away. Hmmm I beg to differ ...

 

[TromboneAl]

Dr. Midei “may have implanted 585 stents which were medically unnecessary”

I bet that patient has trouble getting through airport security.

 

[NW-Bound]

Following is an excerpt from the article to corroborate what MichaelB suspected.

Edward Chaid, 68, a semiretired general contractor from Timonium, Md., is among those who have sued. Five years ago, Mr. Chaid decided to get his first physical examination in decades. Just to be safe, his doctor sent him for a cardiac stress test at MidAtlantic, which revealed a small “squiggle” of concern, Mr. Chaid said. He was sent to Dr. Midei to get his arteries X-rayed, and he emerged from the procedure with two stents.

“Dr. Midei said: ‘You sure are lucky. You had 90 percent blockage.’ And the nurse said, ‘Oh yeah, you were blocked in your widow-maker.’ And I said: ‘Thank God. I guess I’m really lucky you got it when you did,’ ” Mr. Chaid said in an interview.

Five years later, another doctor concluded that Mr. Chaid’s blockage had been minimal. “I was really shocked,” Mr. Chaid said. “I’m from a generation where doctors are thought very highly of.”​

... I also expect Dr. Midei delivered a finely-honed message that made the stent seem all the more imperative. They were not all emergencies, however, and I suspect there are many Doctors that would have given different advice. I know that is easy for me to write, but any remedy to a problem like this has to include individuals being more involved with their health and their healthcare.

 

[travelover]

..........
Some people said the medicare in the States can be fixed right away. Hmmm I beg to differ ...

That was me and I was kidding.

 

[Moemg]

They were not all emergencies, however, and I suspect there are many Doctors that would have given different advice. I know that is easy for me to write, but any remedy to a problem like this has to include individuals being more involved with their health and their healthcare.

With all due respect it is easy to say individuals should be more involved but put somebody in an unexpected life or death experience and 99.9 % will do whatever the Doctor says . Nobody has a cardiac cath unless they are having symptoms and have usually flunked an EKG or stress test so most of them are urgent and certainly emergencies in the patients mind . THe time to be involed in your heathcare is before you are in that position.

 

[Rich_by_the_Bay]

Aren't there guidelines that MDs in the States have to follow ? Here in Canada MDs must follow the guidelines and perform procedures only if it is necessary, and submit claims to get paid by the provincial governments eventually..

There are guidelines for many interventions but they are not mandatory, and often are legitimately ignored due to special circumstances which apply to particular patients.

For purposes of abuse, they are easily ignored.

 

[NW-Bound]

I just reread this

Edward Chaid, 68, ... decided to get his first physical examination in decades... He was sent to Dr. Midei to get his arteries X-rayed, and he emerged from the procedure with two stents.

which reminded me of auto transmission shops that advertise free inspections. Does any customer ever come out of there without a transmission rebuild job?

Hmm... Maybe the saying "If it ain't broke, don't fix it" also applies to annual medical checkups.

 

[Rich_by_the_Bay]

He was sent to Dr. Midei to get his arteries X-rayed, and he emerged from the procedure with two stents

There's plenty of blame in this case to go around but the misleading citation isn't one of them: "getting your coronary arteries x-rayed" in this case implies a cardiac cath, which is the same basic procedure that you undergo when having stents implanted. So the stent may or may not have been indicated, but having a cath and awakening with a stent is routine and usually discussed in advance. Otherwise in proper circumstances you'd have to have two caths -- one to find the blockage and another to place the stent. So, it's usually "if we find anything during the cath we will put in a stent, with your advance permission.

Cardiac cath (with or without stents) is usually not indicated in the absence of symptoms, an abnormal EKG or exercise test or other reason.

BTW, there are indeed other tests that a lay person may describe as "getting his arteries X-rayed" (like calcium scores, CT scans, etc.) but I don't think they apply here.

 

[NW-Bound]

Thanks for the explanation. I have seen a picture of a friend's blood vessel blockage on his heart, which I believe was taken by injection of a radioactive substance, and I thought that was the same procedure here.

 

[Brat]

I am a fan of the Commonwealth Club of California. On 10/10/10 Dr. Robert Pearl (Executive Director and CEO of The Permanente Medical Group) spoke about the future of American health care. It is available as a podcast, I highly recommend it.

John Nieters spoke about traditional Chinese medicine on 11/30/09 and also commented about American health care. He is probably unique in US health care but fascinating nevertheless. Podcast available.

 

[zinger1457]

There is so much Medicare fraud/misuse going on it's staggering, it's estimated to be in the billions. There was a story on 60 Minutes about all these fake medical supply stores set up in Florida collection millions from Medicare by submitting false claims. A good friend told me he needed to get a wheel chair for his elderly mother and a medical supply store told him it would be free and billed to Medicare. After seeing the bill he saw that the medical supply store was actually 'renting' the wheel chair for $1500 a year and billing it to Medicare. He said he thought the rental fee was excessive so looked into. Found out that he could buy the same wheel chair from the same medical supplier for $750.

 

[LuvSouth]

That was me and I was kidding.

I am glad you clarified it

 

[LuvSouth]

Here in Canada, in addition to MDs must follow guidelines set by the Ministry of Health of each province, there are also caps on the income of MDs.

I believe it is $400,000 for MDs, beyond which the MDs can only get a portion of the claims MDs submit, i.e. for each dollar MDs claim beyond $400,000 they only get a portion of it.

Plus, when the provincial government pay out too much to a particular MD, they will review the claims of that MD, and may launch an investigation ...

That's why medical costs in Canada is cheaper than the States ...

This system will "discourage" MDs from performing thousands of stents per year

You see, there are things that medicare or the American government can learn from the Great White North

 

[LuvSouth]

If medicare in the US tries to do what Canada is doing such as putting a cap on income of MDs, non profit hospitals (government run), guidelines, government investigation of suspicious claims by MDs ... it will cause social disobedience ... by MDs and private hospitals ...

It's very difficult to convert the existing full blown capitalism health care system in the US to something similar to Canada or some European countries.

The rich become richer in the States: Capitalism !

Isn't capitalism what the USA is built upon ? The general public continue to fund the high healthcare costs in the US ... making the enterpreneurs (MDs, owners of private hospitals) richer ...

Edit Add: I can't wait to see an election in the US with a president that says "I am going to cap the income of MDs to $400,000 (instead of no cap), any income beyond $400,000 will be heavily taxed. I will also nationalize all private hospitals or turn them into non profit hospitals in such I will bring the healthcare cost down and provide a universal health care to all my fellow Americans ..."

So please don't say it's easy to fix the healthcare problem in the US ...

Good luck !