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A Chill on Patients' Trust

November 09, 2002

Patients want to trust their doctors. Few demand a second opinion, even if they ought to, when a specialist says a surgical procedure is necessary to head off an imminent heart attack. That's what adds such a chill to the stories out of Northern California about cardiologists being investigated for performing risky but possibly unnecessary heart procedures that effectively bolstered their paychecks. So do the questions about whether hospital administrators could have turned a blind eye to possible medical wrongdoing in the name of profits.

The FBI, which is conducting an investigation, has filed no charges against the doctors, Chae H. Moon and Fidel Realyvasquez Jr. Their employers, Redding Medical Center and its parent, Santa-Barbara-based Tenet Healthcare, have not been named targets of investigation. But it's the sort of tale that resonates with patients because of the intense cost and profit pressures on managed-care companies.

The investigation into the coronary-care unit and Medicare payments it generates for the Redding hospital is just part of the story. Red flags appeared late in October after a Wall Street health-care analyst questioned the overall heavy reliance on Medicare payments at Tenet, one of the nation's largest hospital companies.

The federal Department of Health and Human Services then said it would audit Tenet's receipt nationwide of special Medicare payments that are designed to help hospitals defray financial losses from difficult and invasive procedures. Worried investors quickly fled, Tenet's share price took an abrupt nose dive and the company's chief operating and chief financial officers unexpectedly resigned.

Patients can't help worrying about collisions between medicine and profit, because their very lives are at stake.

It's bad enough to think of doctors performing unnecessary procedures for their own gain. It's even worse if the push for profits could combine with a poorly designed and badly monitored Medicare payment program to create an environment that encourages fraud or gaming the system.

Medicare administrators, state regulators and law enforcement have to find out quickly what, if anything, went wrong at Tenet. They also should analyze similar payments to other companies and, if necessary, tighten oversight.

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