Country’s Largest Hospital Chain under Scrutiny for Unnecessary Cardiac Surgeries

This past August, the largest for-profit hospital chain in the United States uncovered evidence that doctors at its many locations performed heart surgeries that were deemed unnecessary.The New York Times reports that in 2010, a former nurse wrote a letter to the chief ethics officer of the chain (called HCA) blowing the whistle on his former employer.

An investigation of 10 hospitals in question recently concluded. Researchers found that the surgeries in question took place between 2002 and 2010. The Times reporter explains, “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.”

Some journalists assert that the motivation for doctors to perform these surgeries is financial: according to The New York Times, HCA’s hospitals in Florida perform thousands of cardiac procedures per year, and Medicare reimburses them approximately $10,000 for each one and about $3,000 per diagnostic catheterization.

It should be noted at this point that HCA firmly denies any wrongdoing. They write that their actions stem from a desire to “demonstrate the strong focus we have on quality patient care.”The Times adds, “The company also says that more than 80 percent of its hospitals are in the top 10 percent of government rankings for quality.”

Sarah Cliff at The Washington Post explains that “our current health care system operates on the ‘pay-for-service’ system, in which, quite simply, patients pay more for more services.” She adds, “There’s a lot of griping about this ‘fee-for-service’ payment model…It nudges doctors to deliver the most health care, even when less could be better for the patient–not to mention better for bringing down health care costs.”

A Reuters report follows up on this last claim: “[P]ressure is growing on the U.S. health care system to find ways to rein in costs…Recent studies have questioned the potential overuse of highly profitable interventional heart procedures in the United States, such as stenting and the placing of ICDs [implantable cardio-defibrillators; both are procedures mentioned in the investigation].”

Cliff, in her article, also adds that this practice is by no means limited to hospitals owned by HCA: “This happens so much that there’s actually a term for it in the medical literature. ‘Oculostenotic reflex’ was defined over a decade ago as the ‘irresistible temptation’ on the part of interventional cardiologists to expand narrowed coronary arteries, despite ‘evidence-based guidelines’ suggesting the use of a different intervention, such as medication (which comes with fewer risks and at a lower cost).” In other words, many patients would benefit from a course of medication, but there is great incentive on behalf of doctors to perform a more advanced and expensive procedure.

This is all troubling and problematic not only because patients often have to pay for unnecessary procedures that their doctors recommend, but also because of the inherent dangers of heart surgery, not to mention the risk of surgical malpractice or other possible personal injuries and complications.