Health Care

Angioplasty, anyone?

May 15, 2015
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Soon there will be a rush for hospitals to enter the field of elective percutaneous coronary interventions. Most commonly referred to as coronary angioplasty, PCI is a proven money maker for hospitals.

For several years, those few hospitals that have had state approval to perform elective PCI hoarded the patients and the resulting fees from those needing valve jobs. Exclusive franchises were protected by the state’s Certificate of Need law.

Previously a hospital’s staff could perform a few PCI procedures on an emergency basis in the event a patient with an acute heart condition arrived at that hospital by mistake and wouldn’t be able to survive the transfer to an approved hospital. Emergency PCI was intended to be just that — on an emergency basis, but rather infrequent. Well, the “infrequent” seemed to become “frequent” over the past few years, and now those hospitals that were to be infrequent want to be able to perform the PCI procedures without pretending to be on an emergency-only basis. They probably have the numbers of cases to prove that they can adequately do the job.

What was at stake for many years was the gold standard of the American College of Cardiology and its Michigan chapter. They had recommended that if such procedures were going to be performed, they should be performed only in facilities that also could perform open heart surgery. Why? Well, in the event of an error or complication, a patient could be whisked from the PCI room to the surgical suite for possible repairs.

Changes being proposed in the Certificate of Need rules soon will make it possible for more hospitals to enter the lucrative PCI field without having open heart surgical facilities. Complications were rare, and the facilities that were able to do emergency work argued that they also should be able to do elective (scheduled in advance) work, even if they did not have open heart surgical capabilities. Who can blame them? There are patients galore and the insurers will pay very well for heart procedures.

Many boomers are getting to the age where heart complications are becoming more common. Also, PCI is a very lucrative procedure, as is open heart surgery. Why should only a few hospitals be able to profit, when others need money as well? Why should the rich get richer and the others lag behind?

Hospitals are businesses. They need to make money to stay in business, and by most standards, the more they make, the better it is for them. The fact that they make their money as a result of patients’ misfortunes also comes into play.

Should you blame the have-nots for wanting to be haves? No!

Blame the insurance companies that richly reward some procedures while skimping on others. Insurers pay a lot for heart care, but skimp on paying for maternity care. High tech children’s heart care is paid handsomely, but care for the many routine childhood issues pales by comparison.

When you consider the insurers’ payments, is it any wonder that medical students want to go into the high paying areas of medicine and avoid becoming the types of doctors we need: family practitioners, pediatricians and obstetricians? Why wouldn’t they want to do procedures that pay well rather than spend time talking with patients, which doesn’t pay?

We get what we pay for, so let’s not complain about the lack of family practitioners or the long wait times to see them. Angioplasty, anyone?

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