Comment on NYT article on Medicare and stents

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On Friday, the New York Times published an article highlighting the inappropriate use of peripheral interventions by several cardiologists and questioning the conflict of interest of in-office interventions for peripheral artery disease and the motives of doctors who perform them.

To say the article sparked debate is an understatement. As of this writing, it is one of three most emailed articles on the nytimes.com, and I have received nearly 100 emails from members who are absolutely outraged at the abuses of care reported--not to mention the ones they themselves have witnessed.

Below is my letter to the editor of the New York Times. I hope you will share your thoughts with me about this issue, ways of reducing procedural fraud, and the role that the SVS should take in addressing this issue. 

If we value our autonomy as physicians and ethical decision-making, we must expose those who place money over patients. 
Peter F. Lawrence, MD
President, Society for Vascular Surgery
Dear Editor:

I believe that most of my colleagues want to provide the best treatment for their patients, but those who don’t should be exposed, as was done in “Medicare Payments Surge for Stents to Unblock Blood Vessels in Limbs.” This article shows how inappropriate care can harm a patient and greatly increase the cost of health care, while grossly enhancing the income of those who overuse procedures. 

Office-based procedures are not inherently bad, if standards for appropriate care are followed. The Society for Vascular Surgery recently held a national symposium to discuss ways to discourage inappropriate use of vascular procedures, and earlier this week, we published evidence-based practice guidelines to encourage appropriate care of peripheral artery disease (PAD).

These guidelines emphasize conservative measures as the first line of treatment for patients without symptoms or with vascular pain only when walking, reserving interventions and surgery for those with more severe problems. They also recommend inexpensive, noninvasive tests to determine whether the pain is truly vascular. These tests should be used in every patient. 

Practice guidelines set standards for our members, but we believe that all physicians treating patients with vascular disease should also use them. Vascular specialists need an in-depth understanding of vascular disease, as well as technical skill, but they also need the ethics to treat patients like a brother or sister—not the source of payment for a new car.

Peter F. Lawrence, MD
President, Society for Vascular Surgery
Chief of Vascular Surgery, UCLA
communications@vascularsociety.org  |  www.vascularweb.org

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