Almost all of the angioplasties at the Elyria hospital are performed by a group of cardiologists at the North Ohio Heart Center. The group's leader, Dr. John W. Schaeffer, says his group treats cardiac patients "very aggressively," and says his doctors simply detect disease more often than doctors in the rest of the country and are quicker to intervene.
However, outside experts say they are concerned that the Elyria doctors represent a larger trend in U.S. medicine, in which doctors make medical decisions based more on financial incentives than what is best and safest for the patient.
For example, Medicare pays the Elyria hospital $11,000 per angioplasty that uses a drug-coated stent, which earns the cardiologist roughly an extra $800. The Elyria doctors performed 3,400 angioplasties in 2004, which is three times the rate of the procedure in Cleveland, just 30 miles away. Dr. Eric Topol, a nationally recognized cardiologist at the Cleveland Clinic, says the Elyria hospital's high rate of angioplasties lacks "a good explanation," and says Elyria does not seem to have different risk factors than the rest of Ohio, which has much lower angioplasty rates.
"It's clear that when doctors and surgeons are financially rewarded for treating patients with certain profitable procedures, many will find a myriad of ways, either consciously or unconsciously, to come up with a diagnosis that benefits their personal bank accounts," said Mike Adams, a consumer health advocate and critic of unnecessary surgical procedures. "This particular practice in Ohio seems to be an angioplasty factory rather than anything resembling genuine health care."
Other healthcare systems have adopted a way of paying doctors that effectively removes financial incentives for prescribing profitable treatments. Kaiser Permanente says its Ohio patients are less likely to undergo the kinds of cardiac procedures performed at the Elyria hospital because its cardiologists work on a salary basis rather than being paid by the procedure.
Though the Elyria doctors say they are doing a good job and caring well for their patients, some experts say doctors with financial incentives to prescribe costly treatments cannot be completely unbiased when assessing how to treat a patient. "It's sort of like, you go to a barber and ask if you need a haircut," says Dr. David D. Waters, chief of cardiology at San Francisco General Hospital. "He's likely to say you do."