CMS may have inadvertently made a common vascular procedure susceptible to abuse when it tried to make the procedure more affordable for hospitals and physicians — leading some to make millions, ProPublica reported May 24.
In 2008, CMS increased payments to physicians' offices that deployed balloons and stents to widen arteries and in 2011, it began reimbursing offices for atherectomies, a peripheral intervention that opens arteries blocked by plaque. Between 2011 and 2014, atherectomies increased by 60 percent and Medicare's overall cost for peripheral vascular treatment jumped by 18 percent.
In 2014, research began to suggest that atherectomies may not be more effective than cheaper alternatives, and in 2019 experts warned the procedure could be associated with higher risk of complications and some physicians could be abusing the intervention. However, CMS did not change its policies. Meanwhile, from 2013 to 2021, the number of atherectomies doubled and payments to physicians nearly tripled, the report said.
"The government is really to blame for setting these tremendously high reimbursement values without looking into whether these procedures are helping people or are just worthless procedures or, in fact, are hurting people," Dipankar Mukherjee, MD, a vascular surgeon and chief of vascular surgery at Inova Fairfax Hospital in Annandale, Va., told ProPublica.
Experts are calling on CMS to reduce reimbursements or investigate physicians with outsized procedure patterns. Some fear patients are caught up in "a new era of profit-driven procedure mills, in which doctors can deploy any number of devices in the time it takes to drill a tooth and then bill for the price of a new car," the report said.
Maryland cardiologist under scrutiny
Jeffery Dormu, MD, and his group, the Minimally Invasive Vascular Center, are an established practice in Maryland. Dr. Dormu is facing multiple lawsuits related to invasive leg treatments he has performed.
Lawsuits include one filed by a man whose leg was amputated after Dr. Dormu administered multiple invasive treatments for mild pain, another filed on behalf of a 62-year-old woman who bled out and died shortly after the procedure and others who claim to have irreversible damage due to the treatments.
According to a ProPublica analysis of CMS data, Dr. Dormu was part of a small pool of physicians performing most atherectomy treatments. From 2017 to 2021, the top 5 percent of physicians conducting atherectomies accounted for more than one-third of all procedures and government payments. CMS paid Dr. Dormu more than $30 million in the past decade for vascular procedures on hundreds of patients, and according to the analysis, he logged more atherectomies and made more money than almost every other physician in America.
Between 2013 and 2017, Dr. Dormu earned about $14.5 million from Medicare, more than 99 percent of other vascular surgeons. And from 2018 to 2021, he earned nearly $18 million in Medicare payments. Nearly $12 million of that came from atherectomies, according to the report.
Read the full report here.