tibor75

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This story brings a smile to my face. You see it all the time...stents placed for the almighty dollar...not for patient care. Patients would be shocked how often it happens. Of course you could say that about a lot of things in medicine...another example of how the fee for service model can turn doctors into criminals.

Here is hoping Midei's career continues to crash and burn....

http://www.nytimes.com/2010/12/06/health/06stent.html?_r=1&ref=health

Word quickly reached top executives at Abbott Laboratories that a Baltimore cardiologist, Dr. Mark Midei, had inserted 30 of the company’s cardiac stents in a single day in August 2008, “which is the biggest day I remember hearing about,” an executive wrote in a celebratory e-mail.

Two days later, an Abbott sales representative spent $2,159 to buy a whole, slow-smoked pig, peach cobbler and other fixings for a barbecue dinner at Dr. Midei’s home, according to a report being released Monday by the Senate. The dinner was just a small part of the millions in salary and perks showered on Dr. Midei for putting more stents in more patients than almost any other cardiologist in Baltimore.

The Senate Finance Committee, which oversees Medicare, started investigating Dr. Midei in February after a series of articles in The Baltimore Sun said that Dr. Midei at St. Joseph Medical Center, in Towson, Md., had inserted stents in patients who did not need them, reaping high reimbursements from Medicare and private insurance.

The senators solicited 10,000 documents from Abbott and St. Joseph. Their report, provided in advance to The New York Times, concludes that Dr. Midei “may have implanted 585 stents which were medically unnecessary” from 2007 to 2009. Medicare paid $3.8 million of the $6.6 million charged for those procedures.

The report also describes the close relationship between Dr. Midei and Abbott Labs, which paid consulting fees to the cardiologist after he left the hospital. “The serious allegations lodged against Dr. Midei regarding the medically unnecessary implantation of cardiac stents did not appear to deter Abbott’s interest in assisting him,” the report states.

The case has turned into a legal quagmire for Dr. Midei and St. Joseph, which have been sued by hundreds of patients who claim they received unnecessary implants. Some doctors say the case has revealed a level of inappropriate care that is more common than most patients know.

“What was going on in Baltimore is going on right now in every city in America,” said Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic, who said he routinely treats patients who have been given multiple unneeded stents. “We’re spending a fortune as a country on procedures that people don’t need.”

Dr. Midei’s lawyer, Stephen L. Snyder, said that his client’s treatment of his patients was entirely appropriate and that Dr. Midei, who has recently practiced medicine at the Prince Salman Heart Center in Saudi Arabia, would be exonerated.

“This is all trumped up to hide the hospital’s criminal conduct,” said Mr. Snyder, who filed a $60 million lawsuit against St. Joseph on Dr. Midei’s behalf accusing the hospital of damaging Dr. Midei’s reputation by making false claims about his care. (The hospital responded that the assessments of Dr. Midei’s care were done by independent experts.)

Last month, St. Joseph agreed to pay a $22 million fine to settle charges that it paid illegal kickbacks to Dr. Midei’s medical practice, MidAtlantic Cardiovascular Associates, in exchange for patient referrals; the hospital did not admit wrongdoing. St. Joseph said in a statement Friday that it now conducts monthly random reviews of stent cases “to assure such a situation cannot occur again.”

As for Abbott Labs, a spokesman wrote in an e-mail that its affiliation with Dr. Midei ended early this year. “Dr. Midei has been a highly regarded physician in his field, with whom Abbott had consulted in the past,” said the spokesman, Jonathan Hamilton. “We have no further comment at this time.”

The case has had wide repercussions. Over the past year, St. Joseph has told hundreds of Dr. Midei’s patients that they did not need the expensive and potentially dangerous stents that the doctor inserted because their arteries were not as obstructed as he had claimed. Now, state health officials are investigating other local cardiologists who inserted a suspiciously high number of stents, which are tiny wire mesh devices inserted to prop open clogged arteries in the heart.

After reports about the Midei case and the wider state investigation, the number of stent procedures performed at St. Joseph and other area hospitals plunged, raising doubts about the appropriateness of much of the region’s cardiac care.

A landmark 2007 study published in The New England Journal of Medicine showed that many patients given stents would fare just as well without them. Dr. Christopher J. White, president-elect of the Society for Cardiovascular Angiography and Interventions, said that inappropriate stenting was a problem, but a rare one. The federal Medicare program spent $3.5 billion last year on stent procedures.
 

atach

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how many times do you have to post about the same subject? do you ever get tired of trolling? We'll wait for you to explain the courage trial again for the 15th time.
 

dragonfly99

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I hope that patients don't read this and think that most cardiologists are greedy individuals who are just lurking and waiting to do unnecessary procedures on them. I'm at a very cath-heavy (but academic) cardiologist fellowship. I can honestly say that while one can have a debate about whether we cath too many people, I've never seen one of our interventionalists putting a stent in a patient unless it was a significant lesion (or they had strong reason to believe it was). Many times they will even do IVUS or FFR (intraprocedure methods to see whether a blockage is hemodynamically significant) before placing a stent. This is in spite of the fact that insurance companies apparently don't pay for the extra time and expense, equipment, etc. that is used to do IVUS or FFR.

I think it's legitimate to have debates about whether we are too aggressive in terms of trying to stent patients, at least some of the time. However, I think that the vast majority of interventionalists, at least the ones I have seen at various academic institutions, are honest and would never assault a patient by purposely placing unnecessary stents in the patient. I don't think we should let a story about 1 bad apple spoil the whole barrel. We (doctors) are bad enough with bashing each other, and various specialties bashing each other. A lot of the public seems to think we are greedy bastards and only the nurses care about them, which isn't true.
 
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tibor75

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I hope that patients don't read this and think that most cardiologists are greedy individuals who are just lurking and waiting to do unnecessary procedures on them. I'm at a very cath-heavy (but academic) cardiologist fellowship. I can honestly say that while one can have a debate about whether we cath too many people, I've never seen one of our interventionalists putting a stent in a patient unless it was a significant lesion (or they had strong reason to believe it was). Many times they will even do IVUS or FFR (intraprocedure methods to see whether a blockage is hemodynamically significant) before placing a stent. This is in spite of the fact that insurance companies apparently don't pay for the extra time and expense, equipment, etc. that is used to do IVUS or FFR.

I think it's legitimate to have debates about whether we are too aggressive in terms of trying to stent patients, at least some of the time. However, I think that the vast majority of interventionalists, at least the ones I have seen at various academic institutions, are honest and would never assault a patient by purposely placing unnecessary stents in the patient. I don't think we should let a story about 1 bad apple spoil the whole barrel. We (doctors) are bad enough with bashing each other, and various specialties bashing each other. A lot of the public seems to think we are greedy bastards and only the nurses care about them, which isn't true.
Of course the vast majority of cardiologists do the right thing. But that doesn't mean much. So, maybe 5% of cardiologists are greedy scumbags? Wouldn't shock me given what I've seen in rural places by cardiologists who place stent after stent.

The dirty secret is that these cardiologists are also reading stress tests. See patient, call stress test positive, cath, place stent.

Patients should realize that many cardiologists have a financial incentive to read abnormal stress tests.
 

Instatewaiter

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This story brings a smile to my face. You see it all the time...stents placed for the almighty dollar...not for patient care. Patients would be shocked how often it happens. Of course you could say that about a lot of things in medicine...another example of how the fee for service model can turn doctors into criminals.

Here is hoping Midei's career continues to crash and burn....

http://www.nytimes.com/2010/12/06/health/06stent.html?_r=1&ref=health

Word quickly reached top executives at Abbott Laboratories that a Baltimore cardiologist, Dr. Mark Midei, had inserted 30 of the company's cardiac stents in a single day in August 2008, "which is the biggest day I remember hearing about," an executive wrote in a celebratory e-mail.

Two days later, an Abbott sales representative spent $2,159 to buy a whole, slow-smoked pig, peach cobbler and other fixings for a barbecue dinner at Dr. Midei's home, according to a report being released Monday by the Senate. The dinner was just a small part of the millions in salary and perks showered on Dr. Midei for putting more stents in more patients than almost any other cardiologist in Baltimore.

The Senate Finance Committee, which oversees Medicare, started investigating Dr. Midei in February after a series of articles in The Baltimore Sun said that Dr. Midei at St. Joseph Medical Center, in Towson, Md., had inserted stents in patients who did not need them, reaping high reimbursements from Medicare and private insurance.

The senators solicited 10,000 documents from Abbott and St. Joseph. Their report, provided in advance to The New York Times, concludes that Dr. Midei "may have implanted 585 stents which were medically unnecessary" from 2007 to 2009. Medicare paid $3.8 million of the $6.6 million charged for those procedures.

The report also describes the close relationship between Dr. Midei and Abbott Labs, which paid consulting fees to the cardiologist after he left the hospital. "The serious allegations lodged against Dr. Midei regarding the medically unnecessary implantation of cardiac stents did not appear to deter Abbott's interest in assisting him," the report states.

The case has turned into a legal quagmire for Dr. Midei and St. Joseph, which have been sued by hundreds of patients who claim they received unnecessary implants. Some doctors say the case has revealed a level of inappropriate care that is more common than most patients know.

"What was going on in Baltimore is going on right now in every city in America," said Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic, who said he routinely treats patients who have been given multiple unneeded stents. "We're spending a fortune as a country on procedures that people don't need."

Dr. Midei's lawyer, Stephen L. Snyder, said that his client's treatment of his patients was entirely appropriate and that Dr. Midei, who has recently practiced medicine at the Prince Salman Heart Center in Saudi Arabia, would be exonerated.

"This is all trumped up to hide the hospital's criminal conduct," said Mr. Snyder, who filed a $60 million lawsuit against St. Joseph on Dr. Midei's behalf accusing the hospital of damaging Dr. Midei's reputation by making false claims about his care. (The hospital responded that the assessments of Dr. Midei's care were done by independent experts.)

Last month, St. Joseph agreed to pay a $22 million fine to settle charges that it paid illegal kickbacks to Dr. Midei's medical practice, MidAtlantic Cardiovascular Associates, in exchange for patient referrals; the hospital did not admit wrongdoing. St. Joseph said in a statement Friday that it now conducts monthly random reviews of stent cases "to assure such a situation cannot occur again."

As for Abbott Labs, a spokesman wrote in an e-mail that its affiliation with Dr. Midei ended early this year. "Dr. Midei has been a highly regarded physician in his field, with whom Abbott had consulted in the past," said the spokesman, Jonathan Hamilton. "We have no further comment at this time."

The case has had wide repercussions. Over the past year, St. Joseph has told hundreds of Dr. Midei's patients that they did not need the expensive and potentially dangerous stents that the doctor inserted because their arteries were not as obstructed as he had claimed. Now, state health officials are investigating other local cardiologists who inserted a suspiciously high number of stents, which are tiny wire mesh devices inserted to prop open clogged arteries in the heart.

After reports about the Midei case and the wider state investigation, the number of stent procedures performed at St. Joseph and other area hospitals plunged, raising doubts about the appropriateness of much of the region's cardiac care.

A landmark 2007 study published in The New England Journal of Medicine showed that many patients given stents would fare just as well without them. Dr. Christopher J. White, president-elect of the Society for Cardiovascular Angiography and Interventions, said that inappropriate stenting was a problem, but a rare one. The federal Medicare program spent $3.5 billion last year on stent procedures.
So what really happened was that Dr Midei was one of the (if not the) most respected interventionalist in Baltimore- which means a lot in a city that houses Hopkins. He was the crown jewel of Midatlantic. Well Midatlantic had a huge deal which would have made every cardiologist in the group a millionaire overnight. He opted to leave the group when a neighboring hospital offered him a sweet deal. Without him, the Midatlantic deal fell through. Midatlantic got pissed and called medicare saying he was performing medicare fraud. The review did not show 500 stents in error as your source says... however St Joes did send out 500+ leaflets to patients saying midei did unneccesary stents in them and now is screwed for doing it as they are on the hook for 20+ million.

Midatlantic is now underinvestigation themselves which is ironic because they were trying to sick medicare on midei to get back at him for leaving the practice and taking the huge deal with him.

Now who are you going to believe... a cardiologist on the forefront of his field or what the gov't says is standard practice? I mean come on. This is not an example of how cardiologist abuse their patients it is an example of how when the gov't says you did something wrong it doesn't matter if you are right or not- if you are on the forefront or not. They have your balls in a vice.
 
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tibor75

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So what really happened was that Dr Midei was one of the (if not the) most respected interventionalist in Baltimore- which means a lot in a city that houses Hopkins. He was the crown jewel of Midatlantic. Well Midatlantic had a huge deal which would have made every cardiologist in the group a millionaire overnight. He opted to leave the group when a neighboring hospital offered him a sweet deal. Without him, the Midatlantic deal fell through. Midatlantic got pissed and called medicare saying he was performing medicare fraud. The review did not show 500 stents in error as your source says... however St Joes did send out 500+ leaflets to patients saying midei did unneccesary stents in them and now is screwed for doing it as they are on the hook for 20+ million.

Midatlantic is now underinvestigation themselves which is ironic because they were trying to sick medicare on midei to get back at him for leaving the practice and taking the huge deal with him.

Now who are you going to believe... a cardiologist on the forefront of his field or what the gov't says is standard practice? I mean come on. This is not an example of how cardiologist abuse their patients it is an example of how when the gov't says you did something wrong it doesn't matter if you are right or not- if you are on the forefront or not. They have your balls in a vice.
Not sure if I trust the government, but I sure as hell don't trust millionaire private interventionalists who put profits over patients. This guy made more money if he put more stents in. You have to be incredibly naive if you don't think this stuff happens all the time in every area of the country.

The fact that this bum is forced to practice in Saudia Arabia makes me laugh.
 
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tibor75

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Why ? What is wrong with practicing in Saudi Arabia ?
Nothing, except that I doubt this guy wants to. Nobody in the US will likely hire this unethical bum.
 

Instatewaiter

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Not sure if I trust the government, but I sure as hell don't trust millionaire private interventionalists who put profits over patients. This guy made more money if he put more stents in. You have to be incredibly naive if you don't think this stuff happens all the time in every area of the country.

The fact that this bum is forced to practice in Saudia Arabia makes me laugh.
Holy self righteous batman.

The fact is, this guy didn't put profits over patients which is why he was so respected
 
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tibor75

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Holy self righteous batman.

The fact is, this guy didn't put profits over patients which is why he was so respected
Agree he was well respected. By industry most of all. They don't just host pig roasts for anybody.
 

ucladukes

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Agree he was well respected. By industry most of all. They don't just host pig roasts for anybody.

Tibor - i'm guessing you are an academic - bottom line is, the vast majority of health care is rendered by the privates and most academics couldn't see 10 patients in a day if their life depended on it. Who else is supposed to read cardiac diagnostic testing, your mom? Obviously cardiologists read them - but the financial incentive to cath is gone. You get waaay more for reading noninvasive studies. A cath is 60-90 minutes of your time that go way less reimbursed then if you spent the same time reading nucs and echos. What is your solution, insist that the government or another cardiologist overread every stress test? You are yelling at the rain. In medicine it is way too easy to call another guy's practice out, but look into yourself. The academic practice of medicine has its own flaws and incredible weaknesses. The guy may be crooked, but the only part of your article that was compelling, is that interventionalists should not be getting kickbacks from the hospital. I believe in FFR, if St. Jude appreciates that and wants me to speak about it, so what, I am a believer and think other people should do it too - that doesn't make me a crook. Maybe the guy is a "bum" but in what high and mighty position are you to judge him?
 

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Unproffesionally I can say why not just blame the patients first for even getting themselves in the condition to even be considered for a PCI/intervention? LOL...

But in all seriousness, big business has big consequences. But the more I read both sides, the more I think the government is out of bounds. What really needs to be addressed is that were those patients probably going to need intervention anyways? Cost vs. Benefit. If the patients went another year and occluded multiple vessels and were found suitable for CABG, which could have been averted by PCI a year earlier would Dr. Midei's interventions been warranted? (viable "cost saving" scenario to the insurance companies/goverment). Or did the insurance/goverment rather favor the people having AMI's and dying instead (biggest cost "savings" for them).

Just thinking outside the box here.
 

jgar26

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A cardiologist is paid the same for the first stent he places versus the 5th stent he places on the same procedure. If the doc is staging multiple procedures, then I can see where he is making the money on this. Its a myth that pervades the public that cardiologists are making millions of dollars stenting 50% lesions. In the time it even takes to do a diagnostic cath and dictate the report (one 45 minutes) paying about $350.00, you could read 10 to 15 nuclear scans (Spect or PET) and make 13-15,000 for the practice. The money on cardiology is in non-invasive imaging and doing large amounts of it. I agree that there is way to much non-invasive imaging going on in cardiology and we as a profession have ourselves to blame for this. Its a big problem. The problem is going to be compounded now that over 50% of cardiologists are going to be employed by a hospital network. That nuc scan that medicare/insurance pays $800.00 for today is now going to be reimbursed 3 to 4 x that tomorrow, further driving up health care dollars. Hospitals have insulated themselves well from declining reimbursements, especially with imaging. Cardiology as a profession has been hit hard by declining and sometimes unfair draconian cuts to office based imaging. Medicare in their infinite wisdom has driven many private practice cardiologists out of business and to become employees for a hospital. The joke will be on all of us though. Expect major increases in medicare spending as a result of these changes made by congress. Eventually, that increase will be further taken from providers, one way or the other. The many "unintended" consequences of this have yet to even be realized by the "policy makers". :thumbdown: