Inappropriate Interventional Cardiac Care?

From the New York Times (http://www.nytimes.com/interactive/2012/08/06/business/Heart-Procedures-…):

HCA Holdings’ stock fell about 4 percent Monday after the company disclosed that the cardiology practices at some of its Florida operations were under scrutiny by the Department of Justice. In its second-quarter regulatory filings, and in a conference call with Wall Street analysts and investors, HCA said the United States attorney’s office in Miami contacted the company in July seeking information about the “medical necessity” of interventional cardiology services at approximately 10 of its hospitals, primarily in Florida. With 163 hospitals stretching across the country, HCA is the largest for-profit hospital operator in the country. The news about the Justice Department inquiry and the potential articles in The Times overshadowed HCA’s second-quarter results, which showed a 71 percent increase in net income in the quarter from a year earlier. At the close, HCA’s stock had fallen $1.05 to $25.55.

What Dr. Samuel Metz noted in response to the NYT article:

1. Physicians do a lousy job of policing themselves.
2. When medical interests of patients conflict with financial interests of hospitals, patients come in second.
3. The optimal therapy of coronary artery disease is medical, not interventional.

My comment:

In appropriate care accounts for hundreds of billions of dollars wasted in the US health care system annually. Many motivations may account for inappropriate care including defensive medicine and/or a desire to help a suffering patient. But it is highly likely that the for profit motive accounts for a major portion of inappropriate care. Hospital administrators who work for HCA have really only one fiduciary duty: make as much money for the investor as possible. They do not really have an accountability to patients. Thus, whatever sells is what they endeavor to sell. And cardiac care makes good profit margins.

Dr. Joe Jarvis