State Regulations Tied to Drop in Common Heart Procedure

Critics worry that the push for good outcomes may reduce access to care for sickest patients

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Dr. Mauro Moscucci, a professor of medicine and chief of the cardiovascular division at the University of Miami Miller School of Medicine, who wrote an accompanying journal editorial, said the study raises two issues.

"First, this study and a previous 2005 study that looked at Michigan show that public reporting can result in the denial of care," he said. "Secondly, as physicians, we are often asked and pressed to perform procedures that may result in no better outcomes."

The Michigan study, which looked at health program payments funded by the auto industry, did not involve Medicare specifically and was not technically public reporting.

Moscucci explained it can take a doctor far longer to explain to a family why a procedure is most likely not going to be effective than it would to simply go ahead and do the angioplasty.

"My concern is that we're doing more and more in patients who will not benefit," Moscucci said. "Physicians want access to new technology, they often stand to gain financially [by doing more procedures] in our fee-for-service system, they are prone to want to please patients, and they are afraid of adverse outcomes, such as a lawsuit, if they refuse to do the procedure."

Commenting on the study, another expert says that despite potential concerns about reduced access to care for the sickest patients, public reporting requirements are only likely to spread.

"The states now reporting won't go back," said Jane Bolin, an associate professor of health policy and management at Texas A&M Health Science Center School of Rural Public Health. "This particular study and others will push for more and more states to improve their outcomes through data. I don't see us pulling back from reporting outcomes publicly."

More information

Learn more about angioplasty from the U.S. National Library of Medicine.

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