August 7th, 2012

NY Times: HCA Concealed Significant Problems at Lucrative Cardiac Centers

Despite numerous internal reviews that turned up a widespread pattern of unnecessary cardiology procedures being performed at many of its hospitals, the giant HCA corporation did little to rein in the problem or to inform regulators, payers, or patients about it, according to an investigative report in the New York Times by Reed Abelson and Julie Creswell. The story was published less than a day after the company disclosed that it was being investigated by the U.S. Attorney’s office in Miami.

The Times recounts numerous instances in which the company discovered a problem at one of its hospitals but then acted to conceal the problem or to prevent its recurrence at other hospitals. In one case, a nurse’s contract was not renewed after he reported to the company that unnecessary procedures were being performed at Lawnwood Regional Medical Center in Fort Pierce, Florida, although an internal HCA investigation had substantiated the allegations.

The Times gained access to internal HCA reviews which found that, from 2002 until 2010, “some cardiologists at several of its hospitals in Florida were unable to justify many of the procedures they were performing” and, “in some cases, the doctors made misleading statements in medical records that made it appear the procedures were necessary.”

At Lawnwood, about half of cardiac catheterizations (roughly 1200) appeared to have been performed on patients “without significant heart disease,” the Times reports. HCA responded that the Longwood numbers were consistent with the national averages. (The Times doesn’t fully explain the numbers, but it should be noted that a study published in the New England Journal of Medicine from the National Cardiovascular Data Registry [NCDR] reported a low diagnostic yield for diagnostic coronary angiography.)

At the Regional Medical Center Bayonet Point, a 44-year-old man with chest pain “suffered a punctured blood vessel and a near-fatal irregular heartbeat after a doctor performed a procedure that an outside expert later suggested might have been unnecessary.” In another case, “a woman with no significant heart disease went into cardiac arrest after a vessel was cut when a Bayonet Point cardiologist inserted a stent.”

An examination of HCA internal documents “reveals that rather than asking whether patients had been harmed or whether regulators needed to be contacted, hospital officials asked for information on how the physicians’ activities affected the hospitals’ bottom line,” the Times reports.

In another episode from 2003, a confidential memo from an HCA cardiac oversight team found that patients at Bayonet Point “were treated for multiple lesions, or blockages, even when ‘the second lesion (or third) did not appear to have significant disease.’ The team went on to note ‘several cases’ in which patients were treated even though their arteries did not have significant blockages.”

A subsequent review by an external company concluded that 43% of angioplasty procedures at Bayonet Point “were outside reasonable and expected medical practice.” In some cases, blockages that had been recorded as 80-90%  were later determined by a “more scientific analysis” to have ranged from 33-53%.

Although the hospital suspended nine physicians after the report, HCA “took steps to withhold details of its conclusions to the media and others, according to internal communications.” The hospital CEO wrote to other HCA executives: “Clearly, we have protected ourselves under the peer review umbrella and have released very little information.”

An outside review found that one cardiologist who worked in the Lawnwood cath lab, Dr. Prasad Chalasani, had been found to be “too quick to perform catheterizations, often without first doing the stress tests necessary to determine whether a patient needed the invasive and costly test.” Nevertheless, he was highlighted in the hospital’s business plan “as being the most profitable doctor at the facility. ‘Our leading EBDITA MD,’ the plan described him.” (EBDITDA is a measure of corporate earnings, the Times notes.)

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