Is "Fee for Service " at Fault in Unneeded Stents

"Fee for Service" appears to be at fault for unneeded stents being placed in the arteries of  patients in hospitals all over the country.

 

Multiple instances of unneeded stents being placed in the arteries of unsuspecting heart patients have been reported.  The most recent is Westmoreland Regional Hospital in Greensburg, Pennsylvania.  Like many hospitals, Westmoreland is owned by a separate corporate entity, Excela Health, that in turn owns other hospitals. On March 3, 2011, Excela sent letters to 141 patients of Drs Morcos and Bousramos informing them that they may have received unnecessary stents.  The stents were all placed in 2010 at Westmoreland Regional Hospital.

 

How could this have happened?  According to Dr Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic, the insertion of unneeded stents by interventional cardiologists is going on in every city in America.  But why would a trusted doctor perform an unnecessary invasive procedure?

 

Perhaps the answer is "fee for service".  Our system does not pay clinicians or device manufacturers to keep us healthy.  There is no money in that.  How do you measure health?  Our system pays doctors and hospitals to do tests, sell devices and perform procedures. Hospitals compete for market share and more and more have adopted standard marketing and sales techniques by branding various sub specialties and driving herds of patients.  Certain hospitals market themselves as "heart centers" or "cancer centers".  Why?   Perhaps because that is where the money is.   When is the last time you saw a "rheumatology center" marketed? 

 

In a December 2010 staff report on cardiac stent usage, the United States Senate Committee on Finance noted that the Medicare system pays hospitals a set free for each diagnosis, regardless of how much the individual patient actually costs the hospital.  Is it any surprise that professional business managers and hospital administrators have found a way to achieve profits by focusing on those procedures and specialties the are most profitable?