The nation’s largest hospital chain, Hospital Corporation of America, has acknowledged that it may be the subject of a federal inquiry into the appropriateness of interventional cardiology procedures at its hospitals in Florida.
The company said in a second quarter earnings call with investors that the U.S. Attorney’s office in Miami had requested information on the medical necessity of such services at 10 hospitals. The revelation came in advance of a lengthy Aug. 6 exposé in the New York Times about questionable cardiology practices at many of HCA’s hospitals.
HCA chairman and CEO Richard Bracken told investors that the company knew the article was going to appear, but was not sure of the exact content. Mr. Bracken also said that HCA would not answer any further questions, but directed investors to a statement on its website.
In that statement, the company said that it was difficult to determine medical necessity of cardiac catheterizations and percutaneous coronary interventions. "These physician-driven decisions have been and are the subject of much debate within the cardiology community," said the statement. Physicians may disagree among themselves, and experts may also not come to consensus, it said. Regarding the volume of the procedures, the company said that "trends for HCA-affiliated hospitals are similar to the rest of the nation for these procedures," and that the number of those procedures had actually declined at HCA-affiliated facilities.
Appropriateness of stenting and other percutaneous cardiac procedures has continued to attract attention, in part because of a Maryland cardiologist, Dr. Mark Midei, who was found to have inserted hundreds of stents unnecessarily, at a cost of millions to Medicare. Dr. Midei has since been the subject of multiple suits alleging harm.
Maryland is now the first state in the nation to have a law that attempts to regulate cardiac procedures. The legislation – signed into law in May by Gov. Martin O’Malley (D) – requires the state "to appoint a Clinical Advisory Group to establish regulations to write requirements for peer or independent review of the placement of stents in heart patients in order to ensure consistency with guidelines developed by the American College of Cardiology and other cardiovascular organizations," according to the Maryland chapter of the American College of Cardiology.