Tags: Heart Disease | angioplasty | overuse | heart | stents | stenting | Dr. Chauncey Crandall

Dollars and Stents: Docs Profit by Overusing Angioplasty

By Charlotte Libov   |   Wednesday, 28 Aug 2013 08:05 AM

Each year, more than a half-million Americans have mesh tubes implanted into clogged heart arteries, making angioplasty the most popular cardiac procedure in the U.S.

Doctors are overusing heart stents in an effort to make up for lost revenue due to health revenue cutbacks, one of the nation’s leading cardiologists tells Newsmax Health.

“Doctor’s incomes are falling because reimbursements are down. They are being squeezed, and the spike in stenting is the result,” says Chauncey Crandall, M.D., head of the cardiac transplant program at the world-renowned Palm Beach Cardiovascular Clinic.

The drop in doctor reimbursements over the years, from Medicare, Medicaid, and private insurers has created a climate in which doctors are scrambling to keep their practices afloat, he says.

“Everyone is doing everything they can to drive up reimbursements, and because the reimbursement is higher for procedures, they are doing as many as they can,” says Dr. Crandall. “Doing these stent procedures is not going to make a physician rich, but they pay at a higher rate than an office visit, so doctors are trying to do as many as they can.”

In many cases, medication and lifestyle changes under a doctor’s supervision are better treatment for an artery blockage than a stent, Dr. Crandall says.  

A new report issued by the American Medical Association found that at a least a third of all angioplasty procedures are “questionable.” The findings showed that at least one in every 11 elective angioplasty is “inappropriate.”

Stable coronary disease – the type that causes predictable chest pain during physical exertion – can be treated with medication such as nitroglycerin, which temporarily widens blood vessels, relieving the pain. Such chest pain is not indicative of a future heart attack, and research shows that in such patients inserting a stent is generally no better at preventing a heart attack than taking medication alone, Dr. Crandall says.

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Former President George W. Bush recently had a stent inserted after his doctors discovered he had a blocked heart artery. Few details have been revealed about his case, so it isn’t known whether he was suffering symptoms.

According to Dr. Crandall, there are times when angioplasty can be a very effective, lifesaving procedure. But its use has skyrocketed in recent years as doctors have expanded its use to patients with stable angina. 

“Stenting can prevent heart attacks, but it’s aggressive therapy,” says Dr. Crandall, author of the Heart Health Report newsletter. “We used to try to use them as a last resort, but young doctors today probably wouldn’t know how to treat chest pain without them. They are relying on Star Wars technology to fix the body without giving the body the opportunity to fix itself, which is always the better option when it’s possible.”

Patients are also part of the problem. “Everybody wants an instant fix. No one wants to take the time to make lifestyle changes, or even take a nitroglycerin pill if they want to go out to play tennis. They want to play tennis and not have to think about it,” he says.

To avoid being the victim of unnecessary angioplasty, Dr. Crandall suggests the following steps:
  • Always get a second opinion, which in most cases is covered by Medicare or private health insurance.
  • Look for a cardiologist experienced in treating heart disease without stenting.
  • Talk to your doctor about different treatment options, including medications and lifestyle changes.
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