Advertisement
  1. Health

Little is clear-cut on HCA's high rates of lucrative heart procedures

A surgical recovery area at Florida Hospital Zephyrhills, which had the highest number of heart catheterizations per bed and the second-highest number of angioplasties in the state, data show.
Published Aug. 19, 2012

HCA hospitals are among Florida's most prolific when it comes to performing two common — and lucrative — heart procedures, state records show.

The nation's largest for-profit hospital chain performed 22 percent more angioplasties and 41 percent more catheterizations per bed than the average hospital in the state, according to 2011 data, the most recent available from Florida's Agency for Health Care Administration.

That translates into big bucks for HCA. Though medication can sometimes be as effective as invasive procedures, catheterizations and angioplasties are relatively minor surgeries with high profit margin.

The state data, reported by individual hospitals, may reflect nothing more than HCA's reputation for cardiac medicine, which has made the chain a preferred stop for many heart patients.

But this month, HCA revealed that the U.S. attorney's office in Miami has launched an investigation into the medical necessity of cardiac procedures at 10 of its hospitals, including several in Florida.

HCA's disclosure of the federal investigation coincided with an Aug. 7 New York Times story detailing a series of internal reviews the company has conducted over the past decade that found overutilization of heart procedures at some of its Florida hospitals.

In 2004, nine cardiologists at HCA's Regional Medical Center Bayonet Point were temporarily suspended after an outside evaluator criticized their practices. At the time, the hospital in Hudson was doing more angioplasties — inserting stents to open clogged arteries — than all but two other, much larger, Florida hospitals.

And, according to the New York Times, after a nurse complained in 2010 about unnecessary heart procedures at HCA's Fort Pierce hospital, an internal review found that about half of its catheterizations — a diagnostic procedure in which a catheter is threaded into the heart — were done on patients without significant heart disease.

In response to the New York Times story, officials at the Nashville-based HCA said that experts often disagree on when a patient should get a stent. They also noted that their hospitals are performing fewer of the procedures than in years past.

But insurance billing records indicate the procedures continue to be popular with Florida's for-profit hospitals and particularly HCA. State data show that for-profit hospitals as a group do nearly 50 percent more catheterizations and one-third more angioplasties than nonprofit hospitals on a per-bed basis.

HCA, which accounts for about half the state's for-profit hospitals reporting invasive cardiac procedures, performed them at even higher rates than their peers, doing 11 percent more catheterizations and 2 percent more angioplasties on average than other for-profit hospitals in Florida.

Dr. Larry Feinman, chief medical officer for HCA in west Florida, said the hospitals see more Medicare patients than other hospitals and "we believe the reputation of our heart services attracts many patients."

Experts say it's natural to see some hospitals doing large numbers of the procedures.

Profit margins are high and heart disease patients are plentiful, noted Jay Wolfson, professor of public health and medicine at the University of South Florida.

"But institutions or individuals occasionally take advantage of the marketplace and wind up pushing clinical necessity and appropriateness because they can," he said.

The result, Wolfson said, is not just excessive cost to the system but unnecessary risk to patients.

Figuring out which procedures are unnecessary, however, is tricky, Wolfson and other experts say.

Hospitals that heavily advertise their heart units — as many HCA hospitals do — attract more chronic cardiac patients than general hospitals. Indeed, the highest number of heart catheterizations per bed and second-highest number of angioplasties in the state took place not at an HCA hospital but at Florida Hospital Zephyrhills, a small nonprofit facility with the only cardiac unit in a 25 mile radius.

Experts also warn that it's impossible to second-guess a physician's decision to intervene without reviewing a patient's medical charts and films. The suspended doctors at Bayonet Point, for instance, all had their suspensions overturned when another panel of doctors found the procedures were within clinical guidelines. Cardiologists usually look for at least 70 percent blockage in an artery before inserting a stent.

Jeremiah Brown, an assistant professor of health policy at the Dartmouth Institute in New Hampshire, said over-reliance on these heart procedures can be driven by something as simple as patient preference. Patients who could solve their problem over time with medication, diet and exercise may prefer to get immediate relief with a stent.

"There's a potential for overtreatment, but whether it's being driven by cardiologists or patient preferences becomes a very muddy point," Brown said.

Kris Hundley can be reached at 727-892-2996 or khundley@tampabay.com.

ALSO IN THIS SECTION

  1. The Tampa Bay Times' annual Medicare Guide explains how the program is set up, helps you compare options available in the Tampa Bay area, and points the way toward help, including free, one-on-one assistance. This illustration will grace the cover of LifeTimes on Oct. 23, when the guide will be published in print. RON BORRESEN  |  Tampa Bay Times
    As the open enrollment period begins, it’s time to review your coverage.
  2. The Medicare Handbook for 2020 is a good resource to have as the annual open enrollment period gets under way. The government usually mails beneficiaries a copy. Find a PDF version to print at medicare.gov/pub/medicare-you-handbook, or call 1-800-633-4227 (1-800-MEDICARE) to order a copy. THOMAS TOBIN  |  Tampa Bay Times
    The open enrollment period, which lasts into December, is a time for millions of beneficiaries to review, and possibly change, their coverage.
  3. Medicare's online Plan Finder has been redesigned and is available at medicare.gov/find-a-plan. THOMAS TOBIN  |  Tampa Bay Times
    The most-used tool on Medicare.gov will look different this year.
  4. Jim Tolbert, left, staffs a booth at a senior expo for Serving Health Insurance Needs of Elders, or SHINE, a state program that answers Medicare and other insurance questions. The program has scheduled a number of events around the Tampa Bay area during Medicare's open enrollment period, Oct. 15 to Dec. 7. Times (2015)
    About 500 volunteers statewide are at the ready. They work for Serving Health Insurance Needs of Elders, or SHINE, now in its 28th year.
  5. In this Sept. 6, 2019, photo, Donna Cryer holds up family photos that include her father Roland Henry, as she poses for a photo in Washington. When her father died, she tried to donate his organs, yet the local organ collection agency said no, without talking to the family or providing a reason. "It was devastating to be told there was nothing they considered worthy of donation. Nada. Not a kidney, not a liver, not tissue,” recalled Donna Cryer, president of the nonprofit Global Liver Institute and herself a recipient of a liver transplant. SUSAN WALSH  |  AP
    Under U.S. transplant rules, the country is divided into 58 zones, each assigned an “organ procurement organization” in charge of donation at death.
  6. Kreshae Humphrey, 26, bathes her daughter, Nevaeh Soto De Jesus, 3, inside of a baby bath tub in the middle of their living room. The parents bathe all three of their girls with bottled water because they believe the children were sickened by the tap water at the Southern Comfort mobile home park off U.S. 19 in Clearwater. The family is suing the park's owner over the issue, but the owner and the state say there are no problems with the drinking water there. MARTHA ASENCIO-RHINE  |  Times
    The owner of Southern Comfort denies there are problems with the drinking water. But the park is still being shut down. All families must be out by Oct. 31.
  7. An arm of the Department of Health and Human Services is taking steps to establish a National Volunteer Care Corps that would recruit healthy retirees and young adults to help seniors live independently. The ranks of Americans age 85 and up are set to swell to 14.6 million in 2040, up from more than 6 million now. Times (2010)
    A federal agency is exploring a national volunteer program modeled after the Peace Corps to help care for the booming elderly population.
  8. Medicare can be confusing. But there's help from trained counselors for SHINE. Serving Health Insurance Needs of Elders is a free program offered by the Florida Department of Elder Affairs and your local Area Agency on Aging. Michele Miller
    Columnist Michele Miller shares her husband’s journey to get on Medicare and how local volunteers can help seniors navigate the system.
  9. Ana Martinez, a medical assistant at the Sea Mar Community Health Center in Seattle, gives a patient a flu shot. Some signs are already pointing to an active flu season in the Tampa Bay area. [TED S. WARREN   |   Associated Press]
    One area hospital has seen a sharp increase this month in children coming in with flu-like symptoms. Health officials are urging people to get a flu shot.
  10. Vagner Lage, 27, and Ayana Lage, 26, pose with a sonogram of their child. JOHN PENDYGRAFT   |  Times
    Pregnancy loss can be isolating and carry guilt and shame. It’s time to end that.
Advertisement
Advertisement
Advertisement