Scheduled emergencies: Is lucrative practice emblematic of a bigger problem?

A Bloomberg News report describes what it calls a "heart surgery factory" at Mt. Sinai Hospital in New York City. But the practice of scheduling emergency procedures in order to maximize reimbursement is widespread, according to Forbes.

The Bloomberg piece claims Mt. Sinai physicians schedule emergency room appointments for patients who don't have insurance and instruct them to describe symptoms of an acute coronary syndrome when they arrive. 

The ER patients get cardiac catheterization at little or no cost and the hospital gets Medicaid reimbursement for the procedure, since federal and state law prohibits hospitals from turning away patients in an emergency, even if they can't pay.

Although no one has publicly accused the hospital of doing anything wrong, James Sheehan, former inspector general of the state's Medicaid system, who now serves as chief of the charities unit for the New York state attorney general's office, told Bloomberg that when pre-scheduled cath-lab patients show up at the ER, it could mean the hospital is trying to receive unwarranted payments from health insurers or federal coverage programs for uninsured patients.

Mount Sinai gives doctors generous financial incentives for conducting procedures at its cath lab, which the hospital describes as the "best and busiest" in the country. Samin Sharma, the director of interventional cardiology, is one of the highest paid physicians--he earned $4.8 million in 2012, the Bloomberg investigation found. And the lab conducts 1,500 more catheter-based treatments than any other procedure performed there, according to the report. 

But Sanjay Kaul, M.D., a leading cardiologist at Cedars-Sinai hospital in Los Angeles, told Forbes that the allegations Bloomberg describes aren't unique to Mt. Sinai or New York City.

Outreach programs that refer patients for expensive--but often unnecessary--procedures that garner generous reimbursements, as well as financial incentives to reward service and generate revenue for hospitals, are part of a more systemic problem throughout the United States, he said.

When uninsured patients who require a heart procedure come through the emergency department, it's "more a blight on the U.S. healthcare environment than any individual hospital," Kaul told Forbes.

"In my opinion," he said, "the article faithfully captures what ails our healthcare system. It targets one hospital to illustrate the issues, but--let me assure you--this hospital is by no means unique in this regard."

To learn more:
- read the article from Bloomberg News
- here's the Forbes piece

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