Steve Stiles
March 07, 2014
NEW YORK, NY — A Bloomberg news report digs into the world of a top New York City hospital’s drive for revenue and a competitive edge in a rough urban market, raising questions about practices that contribute to an image of the center as what is called a “heart-surgery factory”[1]. They include alleged case-volume–driven pay structures for interventional cardiologists, some of whom are “obscenely” well paid; stories about patients presenting to the emergency department for “acute” symptoms but who are already scheduled for the cardiac-catheterization laboratory; and the appropriateness of some procedures given its vast cath-lab volumes.
“No one has publicly accused Mount Sinai of doing anything wrong,” notes the story from Bloomberg reporters David Armstrong, Peter Waldman, and Gary Putka. And there is a glowing appraisal of the Mount Sinai interventional cardiologists from highly regarded Los Angeles cardiologist Dr Sanjay Kaul (Cedars-Sinai Hospital). The story is more of an exposé of the apparent role of money in driving practice at the hospital, which it says has by far the highest interventional case volume of any hospital in the NY region.
“Hospital records show that the lab’s compensation system for doctors incentivizes more procedures,” according to the story. Its massive case volume owes to “thousands of patient referrals each year from a network of affiliated doctors in private practice. Among the most prolific referrers are doctors who’ve had financial arrangements with Mount Sinai, including agreements allowing the hospital to use their offices for a fee, according to documents reviewed by Bloomberg News.”
The story describes Dr Eliscer Guzman as such a doctor, one of several cardiologists on whom the story shines a spotlight. He is said to have referred 471 patients to the Mount Sinai cath lab in 2010, “more than 23 times the average of all referring physicians that year, hospital documents show.”
It continues, “Mount Sinai’s dealings with Guzman also included negotiations over an employment contract for him in 2007 and a plan for the hospital to sponsor a local television show that featured the doctor.”
Also garnering attention is Mount Sinai director of interventional cardiology Dr Samin Sharma, reputed to perform “more complex coronary interventions than any cardiologist in the country” and whom the hospital paid $4.8 million in 2010, according to the story, citing tax documents. “Under Sharma’s leadership, Mount Sinai’s cath lab grew among some of the stiffest competition in the US,” said a former member of the hospital’s cath-lab personnel.
Among the story’s most vivid images: 10 patients presenting to the emergency department over two Sundays in 2012 who said “they’d been instructed to arrive there before their cath-lab appointments, according to internal hospital correspondence. Two of them said they’d been coached to say they were having acute symptoms of heart disease.”
Mount Sinai’s cath lab, the story says, “has regularly scheduled such emergencies-by-appointment, according to three doctors and another medical professional, all of whom said they had direct knowledge of the practice.” Hospital records further suggested that “reports of scheduled ER visits raised a concern internally that some cardiologists might be using the emergency department to get the costs of uninsured patients’ procedures covered.”
References
- Armstrong D, Waldman P, and Putka G. In New York, a heart surgery factory with ‘obscene levels’ of pay. Bloomberg News, March 6, 2014. Available here.