How Some Hospitals Fuel a Money-making Machine
Are some American hospitals risking the health and even the lives of their patients in order to garner greater profits? A recent review published in January, 2014, in a journal from the American Heart Association, of a database of diagnostic coronary angiography in New York State, strongly suggests they are. It found that only 35% of all the coronary angiograms between 2010 and 2011, were definitely appropriate studies, while 25% were considered absolutely without merit. These mindboggling numbers should sound an alarm to anyone who has been scheduled for an angiogram, in any part of our country, and speaks volumes to issues I have been warning the public about since the publication of my book, What Your Doctor Won’t (or Can’t) Tell You, almost ten years ago.
In just that single year there were more than 2,000 patients who had a cardiac angiogram even though they had no symptoms suggestive of coronary disease or even a stress test exam prior to the procedure. In other words, it appears that at least 2,000 people were put through an invasive procedure with risks that include stroke, heart attack, and death, when they didn’t need it.
While the review of the New York Database clearly shows dramatic levels of inappropriate tests, it doesn’t give you an inside view of why some doctors are doing this, nor why the hospitals where these physicians are on staff, seem to encourage it. But as we all know, it’s the same reason why Willie Sutton robbed banks: “Because that’s where the money is.”
For a procedure that can be performed in under half an hour (typically the patient is also observed for a few hours after the procedure), the bill for a simple angiogram can reach $8,000 dollars or more. By comparison, it would require a general practitioner to see about 124 patients, for an intermediate visit, in order to bill $8,000 (based on Medicare rates). An efficient lab should be able to perform around 12 diagnostic angiogram studies in a day, per room, billing around $96,000 dollars.
Seeing the opportunity to make quick cash, many small community hospitals opened labs, even when hospitals with established full-service centers and excellent track records, were just minutes away. Hospitals like New Rochelle Hospital and St. Johns Riverside Hospital opened labs in hopes of capturing huge profits, but closed recently, possibly because patients became better educated and began opting to have this invasive procedure at a hospital equipped and capable of managing them, especially if there were complications during the procedure.
But it’s not only about the “get rich plans” of small hospital administrators that is driving this runaway train. Some hospitals appear so eager to expand their angiography business that they have put profit ahead of patient care. Known to this author are several duplicitous doctors who in the past were shunned and never granted privileges at top hospitals but have now been propositioned to come and perform angiograms at these elite centers. The best physicians, with records of ordering more moderate and appropriate numbers of angiograms, are less likely to be sought after, while marginal doctors with big numbers are propositioned with money-making deals.
Some of the best and biggest hospitals, including hospitals that employ physicians who are active in implementing the same New York State guidelines (that some of their own cardiologists seem to ignore), are looking to reach further out into the community and into the suburban areas of the big cities. They begin by hiring an administrator to become the deal maker. General doctors with large practices and a willingness to accept some form of rent payment, are approached with a deal that will allow the big hospital to place one of its new cardiologists in their office. It’s not easy to generate enough patients who really need complex cardiac testing in just a single-person practice, but with a rent check for a few thousand dollars a month, unwritten goals are made.
I can best illustrate this with a story of a patient who came to see me only after having his cardiac catheterization and seeking answers as to why he needed one and why he now owed over $1,000 in copayment to the hospital.
This patient, a man around 40, with very non-cardiac pains, underwent a stress test at this office. When the study was negative, the traveling cardiologist told the man he should still have a cardiac angiogram and off the man went for his study. That study, of course, was normal, but it generated an $8,000 bill to his insurance that included over $1,000 in copayments due from him. I was unfortunately caught up in this rent-for-consult scheme when that physician, who previously sent most of his cardiac cases to my team, stopped the day his rent check arrived.
The numbers published from the New York State Database are a result of a system that encourages hospitals to perform expensive studies and to seek out physicians, whether or not they are honest and qualified, to fuel a money-making machine, and it is symbolic of the waste and treachery endemic to our healthcare system. Many of us may expect these duplicitous practices from smaller and less elite hospitals but shamefully the biggest and best hospitals appear equally culpable.
About the author: Evan S. Levine, MD FACC, is a cardiologist in New York and a Clinical Assistant Professor of Medicine at Montefiore Medical Center – Albert Einstein College of Medicine. He is also the author of the book “What Your Doctor Won’t (or can’t) Tell You”. He lives in Connecticut with his wife and children.