Prior to 2005, blocked coronary arteries were routinely handled by inserting stents into the blocked artery. Since that time, the number of such procedures have fallen dramatically resulting in a loss of revenue for the doctor or clinic. Some doctors are now performing procedures on peripheral arteries and veins. These procedures are often done in a doctor’s office. However, the procedures are controversial and some medical experts claim they are medically unnecessary. According to the NY Times, “Medical experts are questioning the necessity of some of these treatments, and many believe the condition is more safely treated with drugs and exercise. Nonetheless, some of the nation’s most highly reimbursed cardiologists are making millions of dollars from Medicare for performing these procedures, as payments for relieving blockages in the heart have fallen.
Earlier this month, the Justice Department said it joined two whistle-blower lawsuits accusing one of these doctors of performing unnecessary procedures, including placing a stent in the leg of a patient who later died of complications.” “We’re pretty conservative with how we treat peripheral artery disease,” Dr. Darren B. Schneider, the chief of vascular and endovascular surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, said. “We only perform revascularization procedures on patients with peripheral artery disease who have disabling leg pain or who are at risk of amputation, which is less than 10 percent of all the patients we see.” The procedure is controversial but the financial incentive to perform the procedures is not hard to understand. According to the Times, some procedures can cost as much as $12,000 and Medicare often reimburses the total cost of such procedures. This raises fundamental ethical questions concerning what is in the best interests of the patient rather than the financial bottom line of the doctor.