Most heart doctors don't meet angioplasty standards
Most heart doctors don’t meet angioplasty standards
Most of the physicians who perform coronary angioplasty do not perform the procedure often enough to meet national standards for competency, and their patients are more likely to suffer complications. That is the finding of a study presented recently at the meeting of the American Heart Association in New Orleans.
About 400,000 patients undergo the procedure each year in the United States, and this study is the first to show a link between the experience of individual doctors and their patients’ outcomes. Guidelines from the American Heart Association and the American College of Cardiology recommend that cardiologists perform at least 75 angioplasties per year to maintain competence. Many cardiologists disagree with that standard, however, saying it is too high and would force many to stop doing the procedure altogether.
The study was performed by James G. Jollis, MD, a cardiologist at Duke University Medical Center in Durham, NC. He and his colleagues studied billing records from 97,000 Medicare patients who had angioplasty performed by 6,115 cardiologists. Half of the doctors performed fewer than 14 Medicare angioplasties per year, and Jollis extrapolated that figure to estimate that half of the doctors performed fewer than 40 total angioplasties per year.
The more experienced cardiologists had a complication rate of 4.6%, compared to 6.8% for those doing the procedure less frequently. Jollis calls that difference significant. t
Company under fire for surgical assistants
A Houston company is under investigation for providing surgical assistants who may have been unqualified, leaving area hospitals in the uncomfortable position of defending their alliance with the company.
Assistant Surgeons of Texas provides surgical assistants to five Houston-area hospitals. State Attorney General Dan Morales recently initiated a lawsuit against the company, alleging that 17 of its employees passed themselves off as qualified assistant surgeons when they in fact had very little medical training. A district court issued a temporary restraining order to force the company to stop all operations.
Company representatives deny any wrongdoing, but Morales reports that the state is looking into 10 suspicious deaths at HCA-Columbia West Houston Medical Center. Janie Kauffman, chief executive officer of the hospital, released a statement pointing out that a review by the state health department already had found no association between the deaths and the use of assistants from Assistant Surgeons of Texas. She says there is no reason to think patients were harmed. t
Physician charged with death after providing pain meds
A Miami physician has been charged with first-degree murder in the death of a terminally ill cancer patient, even though the doctor says he administered heavy doses of drugs to relieve the man’s severe pain. The doctor’s lawyer suggests that the case will have a chilling effect on other health care providers who attempt to relieve extreme pain.
Ernesto Pinzon, MD, was arrested Nov. 17, 1996 and charged with the death of patient Rosario Gurrieri, a 70-year-old man with cancer of the lung, liver, and spine. He was indicted Nov. 21, 1996, for first-degree murder. Officials alleged that he intentionally administered a lethal mix of morphine, Valium, and potassium chloride Oct. 6 at Highlands Regional Medical Center in Sebring, FL.
Pinzon’s attorney, Roger Craig, JD, issued a statement claiming that the doctor administered the medications for therapeutic reasons. According to Craig, the morphine and Valium were provided for extreme pain, and Pinzon handled the injections because a nurse refused to give such large amounts. Pinzon later administered potassium chloride to stop the patient’s heart from pounding erratically, his lawyer says. Potassium chloride is used for lethal injection executions in some states. The patient died in 40 minutes.
The State Board of Medicine has suspended Pinzon’s license until the murder case is resolved. t
Beware of federal billing probe
A nationwide effort to crack down on improper billing could put some hospitals in the hot seat. The U.S. Department of Justice has begun to prosecute more than 4,600 hospitals for filing improper claims.
The Justice Department’s "72-hour Window Project" is interested in improper claims related to billing for outpatient services provided in conjunction with inpatient admissions. The 72 hours refers to the time span between the original outpatient service and the inpatient admission. The outpatient service may be challenged by the government if the hospital bills for both outpatient and inpatient service for the same treatment or event.
If federal officials target a hospital’s billing, the hospital will receive a letter describing the regulatory violation. The letter also will explain that the hospital’s exposure will be far higher if it litigates the violation, whereas the government will settle for a comparatively small amount without litigation. A second letter will detail the settlement offer. In addition to a monetary payment, the settlement will require that the hospital implement a training program to avoid future problems, refund copayments and deductibles to patients, and report back to the government on its progress.
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