Government Incentives Leading to Risky Atherectomy Procedures for Vascular Patients, ProPublica Reports

Recent changes to Medicare may be incentivizing doctors to perform unnecessary procedures to clear plaque from blocked arteries, according to a new ProPublica investigative report.

The report indicates since changes were made to Medicare’s payment structure in 2008, there have been massive increases in payments for atherectomies, which are procedures designed to open arteries blocked by plaque with lasers, blades and other less invasive methods than full surgery.

The changes led to office-based payments from Medicare for heart stents increasing from $1,700 to $6,400, balloon implants payments increasing from $3,800 to $4,800, and atherectomies reimbursements for office procedures were set at $13,500 per procedure; compared to $11,450 if the procedure was done in a hospital.

The independent journalism group ProPublica indicates that the number of atherectomies increased by 60% overall from 2011 to 2014.

Medical Malpractice Lawsuits Filed Over Unnecessary Heart Procedures

As a result of the increase in atherectomies, many of which were later determined to be unnecessary, a number of doctors nationwide have faced malpractice lawsuits in recent years, as well as disciplinary actions from state medical boards.

One Maryland doctor, Dr. Jeffery Dormu faces numerous lawsuits after performing more than 3,400 atherectomies in the last 10 years, earning millions of dollars. Last year, the Maryland Board of Physicians suspended his license, put Dormu on two years of probation and fined him $10,000 for performing unnecessary and invasive medical procedures.

One of Dormu’s patients had to have a leg amputated, and another patient bled to death after Dormu began operating on her, according to a wrongful death complaint filed in April 2022 by the woman’s daughter.

However, many of the doctors who have been disciplined, like Dormu, were let off with extremely minor fines, especially in comparison with how much they made off performing the unneeded surgeries, putting their patients at risk of complications and adverse health events that could have been avoided.

According to the ProPublica report, after paying the fines, many doctors and healthcare professionals continued to practice, and potentially, perform more unnecessary procedures for lucrative amounts of taxpayer money.

ProPublica found that from 2017 to 2021, the top 5% of doctors performing atherectomies accounted for more than a third of the procedures nationwide. This means about 90 doctors brought in about $1 billion in government payments for the procedures.

Health experts called for the Center for Medicare and Medicaid Services (CMS) to conduct more oversight on these procedures by reducing reimbursments or investigating doctors who conduct an unusually high number of atherectomies.