Hospitals doing a big business performing costly but unnecessary surgeries is a dog bites man story, meaning it is so common that it’s no longer news. The National Health Care Anti-Fraud Association in 2019 estimated that health care fraud represented as much as $300 billion, or 10 percent of America’s then annual healthcare outlay. Much of this fraud was for costly treatments that weren’t medically necessary.
What’s news is that in 2020, while U.S. hospitals were singing the blues about being overwhelmed treating covid patients, they performed more than 100,000 unnecessary surgeries on the elderly, according to a study released by the Lown Institute, a nonpartisan think tank. In addition to the surgical risks, the unnecessary procedures exposed elderly patients to heightened covid risks, as well as other deadly hospital infections that surged during the pandemic.
The Lown study was based entirely on the Medicare claims data base for 2020, meaning it focused mostly on patients 65 and older. It seems reasonable to speculate that 100,000 is a low-ball estimate of the total number of unnecessary surgeries performed given that its based on patients who qualified for Medicare.
“You couldn’t go into your local coffee shop, but hospitals brought people in for all kinds of unnecessary procedures,” Vikas Saini, a cardiologist and president of the Lown Institute, said in a news release. “The fact that a pandemic barely slowed things down shows just how deeply entrenched overuse is in American healthcare.”
The medical journal BMJ reported Saini disclosed at a press briefing that about one in 100 so-called low value medical procedures results in a hospital acquired infection or some other patient safety event. Additional harm is caused by follow up tests and procedures, known as “cascade events,” he said.
Lucrative stent surgeries
Lucrative stent surgeries were among the most common unnecessary surgeries performed during the first year of the pandemic. The science – and we know that U.S. hospitals rigidly “follow the science,” – is very clear that most stent procedures are unnecessary.
A landmark study published in the New England Journal of Medicine in 2020 found that inserting stents in stable patients with coronary disease offered limited benefits. Even prior to the release of the study there was considerable evidence suggesting that stent procedures were of questionable benefit, yet hospitals continued to perform them almost unabated.
“The evidence that elective stents in stable patients add nothing but increased cost and risk to patients (receiving optimal medical treatment) is irrefutable,” Dr. William Bestermann Jr., an internist specializing in preventive cardiology, wrote in a commentary expressing his dismay about the continued popularity of stent procedures.
Bestermann said it’s all about the mighty dollar.
“Stents in stable patients have not decreased because of perverse financial incentives,” he said. “Stents and hospitalizations generate a lot more money than OMT which only requires primary care office visits and proven generic drugs.”
Houston Methodist and Cleveland Clinic were the leaders among the top ranked hospitals billing Medicare for stent surgeries in 2020, performing the procedures at least double the national average. Nipping on their heels were Mt. Sinai in New York City and Barnes Jewish Hospital in St. Louis. Other prestigious hospitals ranking high on the list were NYU Langone Hospitals, Ronald Reagan UCLA Medical Center, Cedars-Sinai Medical Center, Michigan Medicine, Stanford Health Care, and Rush University Medical.
A deserved shoutout for Houston Methodist
It’s noteworthy that Houston Methodist ranked at the top of its prestigiously ranked peer group for doing lucrative stent surgeries. Houston Methodist last November publicly derided Dr. Mary Talley Bowden, a Houston ENT doc, for “spreading dangerous misinformation not based in science.” What sparked Houston Methodist’s ire was Bowden’s use of ivermectin, a drug the FDA and CDC insisted was ineffective treating covid, but other credible doctors in the U.S. and around the world say it can be beneficial, particularly in the early stages of the disease.
I profiled Bowden in February and the slew of hostile media coverage the Stanford trained otolaryngologist received because of Houston Methodist’s public denouncements of her covid treatments. When Houston Methodist suspended Bowden’s hospital privileges, Bowden learned of the decision from a local reporter who was leaked the information. Another Houston reporter published an article essentially questioning why Bowden’s license hadn’t been suspended. Bowden became national news, with the media universally siding with Houston Methodist.
As best I can tell, not one of the Houston or national news outlets that published articles slamming Bowden have reported on the Lown study’s findings about Houston Methodist. Unlike Dr. Fauci, Bowden to my knowledge holds no drug patents and received no financial benefit prescribing ivermectin. In fact, prescribing the drug cost her money because the major drug store chains, in cahoots with the American Medical Association, wouldn’t fill scripts for ivermectin. Bowden scrambled to help patients get the drug from independent pharmacies.
Another doctor who from the get-go advocated the use of ivermectin and other low-cost drugs to treat covid was Dr. Peter McCullough, who prior to advocating his controversial position was considered among the leading cardiologists in the world. I profiled McCullough last August and how he was banished from his position at Baylor Scott & White in Dallas because of his controversial covid views and related media appearances.
McCullough did his fellowship training under Dr. Joel Kahn, a Michigan cardiologist who was repeatedly censored on social media because of his concerns the government wasn’t fully disclosing vaccine risks and his support of ivermectin.
McCullough and Kahn don’t do stent procedures. In fact, Kahn published a commentary in 2019 warning about the overuse of stent procedures.
Yet Bowden, McCullough and Kahn are the physicians who have been publicly maligned. Houston Methodist touts that U.S. News ranked it the 16th best hospital in the country.
For the record, I didn’t discuss this post with Bowden, McCullough or Kahn or anyone connected to them. I doubt they were even aware of the Lown study. A source sent me a story about the findings and Houston Methodist’s ranking struck me as especially notable.
Egg on my face
Admittedly, the Lown study leaves me with egg on my face. I’ve long admired Cleveland Clinic from afar. I published this fawning profile of the institution last August, noting that CEO Tomislav Mihaljevic is an elite cardiac surgeon, having performed more than 3,000 procedures and published more than 140 peer review articles. He holds a patent on a novel system for minimally invasive cardiac surgery.
A hospital doing a high volume of unnecessary stent surgeries during the pandemic isn’t a good look, particularly when the CEO is a cardiac surgeon.
I was disappointed that Cleveland Clinic figured prominently in this USA Today story about hospitals suing patients who publicly criticize their doctors. Further bursting my Cleveland Clinic bubble was a passage in the book Davos Man quoting Mihaljevic praising Stephen Schwarzman, the multibillionaire founder of Blackstone, a private equity firm that has caused significant adverse disruption to the U.S. healthcare industry, particularly emergency medicine.
Not surprisingly, the American Hospital Association, a trade group I perceive is focused on promoting the financial interests of U.S. hospitals and their mostly overpaid CEOs, took issue with the Lown study.
In a statement shared with Becker’s, Aaron Wesolowski, the AHA’s president of policy research, analytics and strategy, insisted the Lown study was “misleading” and said it has limitations and flaws, including the narrow focus on Medicare patients, use of only claims data and methodology gaps.
I trust the Lown Institute
I trust the Lown Institute, especially since cardiology is in its DNA.
The Lown Institute, based in suburban Boston, was founded in 1973 by Bernard Lown, a Harvard cardiologist who invented the defibrillator, which has saved countless lives. Earlier, Lown was expelled from Johns Hopkins School of Medicine because he protested medical segregation by altering blood-bottle labels that denoted a donor’s race.
Lown and Soviet cardiologist Dr. Evgeni Chazov founded the group International Physicians for the Prevention of Nuclear War (IPPNW) to unite physicians around the world against nuclear proliferation. The two were awarded a Nobel Peace Prize in 1985.
Lown died in 2021. My sense is that he would admire and respect Drs. Bowden, McCullough, and Kahn for acting on their consciences and refusing to cave to political pressures, much like he did.
Houston Methodist? I’m not so sure.