Mt Sinai Cardiology Scandal?

[StrangerX]

One of my attendings was talking about this:

http://www.bloomberg.com/news/2014-...kes-nyc-heart-emergencies-by-appointment.html

How does something like this impact your ability to get a fellowship in cardiology coming out of or at this institution? What about research opportunities? I hope not much.

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[anbuitachi]

Not much.. its Mt sinai, one of the top IM programs in NYC. And just because its published in bloomberg doesn't mean it's the truth, besides even if it is, it's an ethical issue

 

[amine2086]

One of my attendings was talking about this:

http://www.bloomberg.com/news/2014-...kes-nyc-heart-emergencies-by-appointment.html

How does something like this impact your ability to get a fellowship in cardiology coming out of or at this institution? What about research opportunities? I hope not much.

The IM residents have nothing to do with the scandal itself. So I don't see how it would impact their fellowship opportunities as long as they don't get LOR from one of the involved cardiologists. On the other hand it will likely impact Mount Sinai's ability to recruit top notch cardiology fellows.

 

[CanIMakeIt]

The IM residents have nothing to do with the scandal itself. So I don't see how it would impact their fellowship opportunities as long as they don't get LOR from one of the involved cardiologists. On the other hand it will likely impact Mount Sinai's ability to recruit top notch cardiology fellows.

You really think so? Will they be suffering/struggling to recruit top fellows like Cleveland clinic currently is after the supposed Eric Topol saga. /end sarcasm

 

[IMDoc607]

Sharma should be investigated and prosecuted if he if wrong. If he is doing nothing wrong, then Mount Sinai should welcome an investigation as this gives cardiology a HUGE black eye. As a future cardiologist and hopeful interventionalist I do not need my career to be hindered by greed of this nature (if its true).

 

[anbuitachi]

Sharma should be investigated and prosecuted if he if wrong. If he is doing nothing wrong, then Mount Sinai should welcome an investigation as this gives cardiology a HUGE black eye. As a future cardiologist and hopeful interventionalist I do not need my career to be hindered by greed of this nature (if its true).

Is it just greed though? I'm not a doc yet, but what can they do for those patients w/ no insurance, who needs cardiac cath, but can't afford it? send them home and wait for that heart attack?

 

[IMDoc607]

Is it just greed though? I'm not a doc yet, but what can they do for those patients w/ no insurance, who needs cardiac cath, but can't afford it? send them home and wait for that heart attack?

Great question....I am saying that if there is nothing to hide Mt Sinai should welcome an investigation to prove they are nothing but the best. If he is vindicated, then CMS and everyone can STFU a leave us cardiologists alone. We are saving lives and doing it right.

 

[throw away]

Is it just greed though? I'm not a doc yet, but what can they do for those patients w/ no insurance, who needs cardiac cath, but can't afford it? send them home and wait for that heart attack?

It may not be greed, but it is certainly insurance fraud and is illegal.

Also you are missing a major underlying issue. Recent large studies showed that most non-emergent caths do not improve outcomes over medical management. Non-emergent caths in most patients are no longer medically indicated unless certain parameters are met. However many hospitals are continuing to perform them in large numbers because patients like them and they make the hospitals lots of money. That's part of why these doctors (allegedly) coached their patients to complain of chest pain--it makes the non-necessary procedure automatically seem more justifiable because it raises false concern for a heart attack. This is why people are accusing the physicians of being greedy.

 

[europeman]

If I talk to any resident in any field at Sinai, they will attest that it's true

 

[Instatewaiter]

You really think so? Will they be suffering/struggling to recruit top fellows like Cleveland clinic currently is after the supposed Eric Topol saga. /end sarcasm

Haha. Most of the people applying to CCF don't even know about the Topol saga.

Sharma should be investigated and prosecuted if he if wrong. If he is doing nothing wrong, then Mount Sinai should welcome an investigation as this gives cardiology a HUGE black eye. As a future cardiologist and hopeful interventionalist I do not need my career to be hindered by greed of this nature (if its true).

Interventional cardiology has been under the gun for a while. As appropriateness criteria keep getting stricter and stricter, it's only going to get worse. You have to play the game to have your patient fit in their little box to get an intervention. And people are seeing their incomes plummet despite working terrible hours and taking STEMI call. That promotes people to do some shady things.

Interventional cardiology, in the end, is probably not going to be worth the effort. Reimbursement is plummetting and in a few years they may not be paid much more than many other subspecialties of cardiology.

 

[Instatewaiter]

Great question....I am saying that if there is nothing to hide Mt Sinai should welcome an investigation to prove they are nothing but the best. If he is vindicated, then CMS and everyone can STFU a leave us cardiologists alone. We are saving lives and doing it right.

As an institution, you don't want CMS to investigate you. They can always play Monday morning quarterback and there are so many asinine rules they will always find something. And in a random review if they find, 5 or 10% of a random sampling of cases were questionable, they will fine you 10% of all the cases you have done. It can be a disaster for a hospital system. Add to that the stigma of just having a CMS investigation...

This happened in the a major case in Baltimore that was on the Heart.org. A group was pissed off that one of their major cardiologists was going to leave and take with him a major contract. They called CMS on him and he was run through the ringer by CMS for fraud, inappropriate stenting and the like. Well CMS then looked into the whistle blowing group and they are now being investigated for fraud. Once CMS gets involved you are going to be screwed no matter what.

 

[Instatewaiter]

It may not be greed, but it is certainly insurance fraud and is illegal.

Also you are missing a major underlying issue. Recent large studies showed that most non-emergent caths do not improve outcomes over medical management. Non-emergent caths in most patients are no longer medically indicated unless certain parameters are met. However many hospitals are continuing to perform them in large numbers because patients like them and they make the hospitals lots of money. That's part of why these doctors (allegedly) coached their patients to complain of chest pain--it makes the non-necessary procedure automatically seem more justifiable because it raises false concern for a heart attack. This is why people are accusing the physicians of being greedy.

Perhaps you could be more vague. Nothing is indicated unless certain parameters are met. 🙂

Refractory angina is a good reason to stent.

 

[IMDoc607]

As an institution, you don't want CMS to investigate you. They can always play Monday morning quarterback and there are so many asinine rules they will always find something. And in a random review if they find, 5 or 10% of a random sampling of cases were questionable, they will fine you 10% of all the cases you have done. It can be a disaster for a hospital system. Add to that the stigma of just having a CMS investigation...

This happened in the a major case in Baltimore that was on the Heart.org. A group was pissed off that one of their major cardiologists was going to leave and take with him a major contract. They called CMS on him and he was run through the ringer by CMS for fraud, inappropriate stenting and the like. Well CMS then looked into the whistle blowing group and they are now being investigated for fraud. Once CMS gets involved you are going to be screwed no matter what.

Good point....amazing how their reimbursements are plummeting but salaries are still high. Why the disconnect? Is it production based etc?

 

[Instatewaiter]

Good point....amazing how their reimbursements are plummeting but salaries are still high. Why the disconnect? Is it production based etc?

The still bring in MASSIVE amounts of money for the hospitals through facility costs. Also, even though reimbursement is plummetting, they still do good business and will always make good money. Salaries may be high but they are much lower than they were a few years ago.