AllMed Addresses Overutilization in Interventional Cardiology Procedures: Catheterization & Stent Placement

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In a recent webinar, AllMed Healthcare Management discusses how hospitals can measure and monitor the medical necessity of high risk procedures to increase quality of patient care and safety.

AllMed Healthcare Management

Improving the Quality & Integrity of Healthcare

"Optimal patient care relies on reducing the number of unnecessary interventional cardiology procedures, thereby improving the efficacy of procedures and preventing significant potential risks and complications." - Dr. David Kong

Approximately 600,000 percutaneous coronary interventions (PCI) and 1,061,000 diagnostic cardiac catheterizations are performed in the United States each year, at a cost that exceeds $12 billion. Overutilization, abuse, and fraud within cardiology service lines continue to receive increasing scrutiny from state and federal agencies, prompted by high-profile lawsuits related to questionable physician and hospital practices.

During a recent webinar hosted by AllMed Healthcare Management, Dr. David Kong, a board-certified cardiologist, discussed measures related to addressing overutilization issues in interventional cardiology. “Optimal patient care”, said Dr. Kong, “relies on reducing the number of unnecessary interventional cardiology procedures, thereby improving the efficacy of procedures and preventing significant potential risks and complications.” Although invasive heart procedures can be lifesaving for patients who have heart disease, patients who undergo unnecessary cardiac catheterization or stent placement are exposed to unnecessary risks and potential complications.

Dr. Kong noted that “Cardiovascular medicine has comprehensive clinical practice guidelines and appropriate use criteria endorsed by its major professional societies. As technologies and therapies continue to evolve, interventional cardiologists, hospital administrators, payers, and regulators face the ongoing challenge of determining what is appropriate according to the latest evidence-based guidelines.”

Identifying and correcting overutilization and/or substandard physician performance before they spiral out of control, can help hospitals reduce litigation costs and other legal battles. The consequences of retaining or contracting providers who perform unnecessary cardiac procedures are becoming more negative, and include:

  •     Reduction in reimbursements from RAC and MIC audits
  •     Exclusion from federal and state health program participation
  •     Investigations by DOJ & OIG, up to and including filing of criminal charges
  •     Potential legal liability for any injuries to patients
  •     Loss of accreditation by healthcare standards organizations

As hospitals struggle to measure and monitor the medical necessity of interventional cardiology procedures being performed in their facilities, ongoing external peer review can be used to supplement hospitals’ internal review processes. Independent review organizations utilize large networks of physicians, which allow for more timely and economical reviews and also improve compliance with evidence-based guidelines.

According to Dr. Amy Marr, Associate Medical Director of AllMed, “Internal hospital peer review faces inherent challenges such as conflicts of interest and timeliness.” Outsourcing peer review to an unbiased third party, she said, not only tackles these issues, but also ensures that physician performance is objectively evaluated, and gives hospitals the means to tighten clinical criteria and provide additional training to physicians.

About AllMed
AllMed Healthcare Management provides external peer review solutions to leading hospital groups and ASCs nationwide. AllMed offers MedEval®, MedScore® and CardioAudit®, which help facilities improve physician performance through both periodic and ongoing case reviews at the individual or departmental levels. Services are deployed through PeerPoint®, AllMed’s state-of-the-art medical review portal. For more information on how AllMed can help your organization improve the quality and integrity of healthcare, contact us today at info(at)allmedmd(dot)com, or visit us at http://www.allmedmd.com

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Kiki Grant
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