Drugs, bypass surgery and vessel-clearing procedures like angioplasty are the various treatments for people with blocked coronary arteries.
Elyria is a small industrial city in northeast Ohio. Doctors here , more than anywhere else in the country, would suggest their patients to go for Angioplasty-- a treatment that typically involves threading balloon catheters through arteries and sometimes placing drug-coated stents to unblock them. Medicare patients in Elyria receive angioplasties at a rate nearly four times the national average. Thus, commercial insurers have begun to raise questions. But the doctors are not accused of having done anything wrong.
All the all the procedures at the Elyria hospital are performed by a group of cardiologists who dominate coronary care in this city and are passionate about angioplasties, the highly profitable procedure in which they specialize. Whether angioplasty is good for the patient is open to medical debate. .
"We do manage very aggressively the patients we care for," said Dr. John W. Schaeffer, the founder and president of the group, the North Ohio Heart Center, which employs 31 cardiologists. .
But experts are worried about how medical decisions in this country can be influenced by financial incentives and professional training more than by solid evidence of what works best for a particular patient. .
"People are rewarded for erring on the side of an aggressive, highly expensive intervention," said Dr. Elliott S. Fisher, a researcher at Dartmouth Medical School, which analyzed Medicare data and found Elyria to be an outlier. .
Elyria's community hospital, EMH Regional Medical Center is getting paid $11,000 by Medicare, for an angioplasty involving use of a drug-coated stent. The cardiologists may get $800. Doctors in North Ohio perform several angioplasties a year, for instance, 3,400 in 2004! .
Elyria's rate of angioplasty is 3 times higher than that of Cleveland,just 30 miles away!
Medicare pays EMH Regional Medical Center about $25,000 for a bypass operation, and around $2,200 to the surgeon. The Elyria cardiologists do not perform bypasses as they are not surgeons. The bypasses are performed here by surgeons from the Cleveland Clinic. . But even in cases of extensive disease, the Elyria doctors say they prefer the use of stents where other doctors might typically recommend bypass surgery. .
The doctors say they do prescribe drug-only treatment for patients with less serious disease. But generally, Dr. Schaeffer argues, the group's aggressive use of angioplasty provides the best results for its patients. "We have excellent outcomes," he said.