Peer review traditionally has focused on adverse patient outcomes. But Maryland's top health regulator, Secretary of Health John Colmers wants to see peer review expanded to take into account concerns related to volume and the necessity of medical services.
His comments were part of a report sent to a key lawmaker Tuesday that offers an update on the state's continuing probe into allegations of unnecessary stenting at Maryland's hospitals. The probe was sparked by revelations that Dr. Mark Midei, who operated at Saint Joseph Medical Center in Towson, Md., had allegedly put nearly 600 unnecessary stents into patients and doctored medical records. The investigation has since expanded.
During an onsite survey, state investigators learned that St. Joseph's peer review process allowed Midei, who was chair of the cardiology department, to choose cardiology cases, including his own, for peer review. St. Joseph's has since revised its practices to include an independent, blind review of interventional providers and assured that clinical heads may not select nor review their own cases.
The state continues to seek outliers, or hospitals and other medical facilities where the share of cardiac stent procedures far exceeds the state average, the Baltimore Business Journal reports. Two other hospitals--Baltimore-based Union Memorial and Washington Adventist Hospital in Takoma Park--consistently exceeded all other Maryland facilities in the use of stents, the Baltimore Sun found. They surpassed the state average by 20 to 30 percent over the past five years.
"Maryland is just the tip of the iceberg," medical malpractice attorney Jay Miller told the Sun. He represents more than 190 of Midei's stent patients. He claims the overuse of stents is not confined to St. Joseph's Hospital and Midei.
It's possible that the agency that sets hospital rates could retroactively make rate adjustments for procedures deemed unreasonably expensive, according to the Business Journal. It wouldn't be the first time.
The report concludes that regulators are mostly powerless to prevent medical fraud, the Sun reports.
To learn more:
- read the report
- read the Baltimore Sun article
- here's the Baltimore Business Journal article