Medical experts question procedures for peripheral artery disease amid Medicare payment surges

As the med tech industry homes in on next-generation devices for peripheral artery disease, medical experts are questioning the necessity of procedures to treat the disease, pointing to large Medicare payments made to physicians performing the operations.

An analysis of the 2012 billing records for the 10 top-billing cardiologists in the country showed that 8 of the doctors made about half of their reimbursements from Medicare by performing procedures to ease the narrowing of arteries or veins in patients' arms and legs, The New York Times reports. The increase in procedures marks a shift in Medicare-paid operations, as the number of procedures to open blockages in heart vessels fell by about 30% from 2005 to 2013, while the number of procedures for vessels outside the heart jumped 70% during the same period.

But many medical experts are cautioning against widespread use of the treatment, saying that most patients with peripheral artery disease can be treated with exercise, weight loss and medication, according to the Times article. Patients with severe cases could benefit from the procedure, however, to avoid leg amputations.

"We're pretty conservative with how we treat peripheral artery disease," Dr. Darren Schneider, chief of vascular and endovascular surgery at New York Presbyterian Hospital/Weill Cornell Medical Center, told the newspaper. "We only perform revascularization procedures on patients with peripheral artery disease who have disabling leg pain or who are at risk of amputation, which is less than 10% of all the patients we see."

The spike in procedures also prompted a regulatory crackdown on physicians performing the procedures. In 2011, the U.S. Department of Justice joined a whistle-blower lawsuit alleging that Dr. Elie Korban, a Jackson, TN-based cardiologist, falsely billed Medicare for unnecessary cardiac procedures in patients.

Earlier this month, the Justice Department said it would investigate payments made to Dr. Asad Qamar, an Ocala, FL-based cardiologist who received $18 million from Medicare in 2012, making him the top-billing cardiologist in the country. Qamar was also the leader in billing for procedures to treat peripheral blockages, with $13 million of the total $18 million in payments he received from Medicare coming from operations to treat arteries mainly in the legs, the Times reports.

Still, consensus about the best treatment procedures for patients with peripheral artery disease is lacking. "The evidence base is not as clear," and it was only in the past year that a doctors' professional society issued general guidelines for procedures done outside the heart, Brian Contos, an executive director of the Advisory Board consulting firm, told the newspaper. Uncertainty from physicians and medical experts could spark future probes and discussions on whether to carry out the procedures in patients.

"There is just a wide gray zone that is going to receive additional scrutiny," Contos said (as quoted by the Times).

- read the NYT story (sub. req.)