Westmoreland Hospital, the Pennsylvania Hospital where 2 cardiologists have been accused of implanting stents in patients who did not need them, had an exceptionally high volume of stent procedures, according to an article in the Pittsburgh Tribune-Review by Luis Fabregas.
The hospital, with only 364 beds, implanted 1,297 stents in fiscal year 2010, the fourth-highest number in the state of Pennsylvania. The hospital’s volume was greater than the volume at several much larger major hospitals in Pennsylvania. Dr. Jerome Granato, the chief medical officer of the hospital’s parent company told the paper: “The pattern is high for a demographic of this size and a hospital of this size.”
The Tribune-Review reported that nearly 40,000 stents were implanted in the state of Pennsylvania during one year and that the 82 hospitals where the procedures took place charged more than $2.7 billion. The 2 cardiologists, Ehab Morcos and George Bousamra, performed more than one-third of the stent procedures at the hospital.
The article also reports that the hospital tried twice to hire the cardiologists in February 2010, before becoming aware of the stent problem. “The offers included a hybrid model allowing the doctors to stay in private practice; both models contained incentives for reducing complications and improving outcomes,” a hospital spokesman told the paper.
The hospital said the review was started “after other physicians complained of a pattern of excessive stent use” and denied that the current controversy was part of an effort to retaliate against the 2 cardiologists for not joining the hospital.
Comment: It’s worth emphasizing the fact that about a year before this controversy erupted the hospital had tried to hire the 2 cardiologists. In other words, the extreme high volume of these cardiologists– which should have been a warning sign, or at least a call for aggressive peer review– was actually seen as a highly desirable characteristic. Until it wasn’t.
If they are in fact guilty then of course there is no excuse for the misdeeds of the 2 Pennsylvania cardiologists (as well as their even more notorious fellow interventionalist, Mark Midei). But that doesn’t mean they weren’t enabled, and perhaps even subtly encouraged, by a healthcare system and a medical culture that rewards high reimbursement procedures and includes only minimal checks and balances to ensure that those procedures are medically necessary and justified. The Maryland and Pennsylvania scandals are inevitable occurrences in a system that lavishly rewards high producers. So we shouldn’t be surprised when the Fantasy Island of enormous profits and prestige turns into the Devil’s Island of scandal, lawsuits, and legislation.
Hat tip: Marilyn Mann, yet again.