Fee-for-service payments incentivize unnecessary cardiac surgeries

Lucrative reimbursement for cardiac procedures in Medicare's fee-for-service model is at the heart of an investigation involving three Indiana surgeons accused of performing unnecessary surgeries on hundreds of patients while the hospital turned a blind eye, according to the New York Times.

Three cardiologists in Munster, Indiana are facing lawsuits from 293 patients in the small Midwestern town; the lawsuit alleges that the surgeons performed unnecessary cardiac procedures involving stents and pacemakers. The claims led some physicians to partner with medical malpractice attorneys--generally regarded as the mortal enemy of providers--in an effort to curb unnecessary cardiac surgeries, which prompted an investigation from the Indiana Medicaid program and the U.S. Attorney's office.

In 2012 and 2013, Dr. Arvind Gandhi, Dr. Wail Asfour and Dr. Satyaprakash Makam, of Cardiology Associates of Northwest Indiana, received the highest reimbursement of any cardiologist in the state, bringing in nearly $5 million combined in 2012, according to the Times. In the past, highly reimbursed cardiologists, like Asad Qamar, have drawn scrutiny from federal investigators following the Centers for Medicare & Medicaid's release of physician payment data.

Experts like Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic and the former president of the American College of Cardiology, have pointed to the nature of cardiology billing, noting that steep reimbursement exposes the specialty to abuse.

"Cardiology, whether we like it or not, is generally a big moneymaker for hospitals," Nissen told The Times. "We are still a fee-for-service system, and that creates, in my view, misaligned incentives among some physicians to do more procedures and among some institutions, particularly in areas where there is not tight medical supervision, to turn a blind eye and enjoy the high revenue stream."

Cardiology procedures have been targeted by federal officials over the last several years, leading to multi-million dollar settlements from two providers in Kentucky. In June, Westchester Medical Center paid $18.8 million to settle allegations of unnecessary cardiac procedures; meanwhile a cardiologist in Ohio was convicted of overbilling Medicare $7.2 million for stents, catheterizations and nuclear stress tests.

For more:
- read the New York Times article