Mount Sinai Hospital Plans External Review of Cath Lab’s Quality

The head of cardiology at New York’s Mount Sinai Hospital is starting an outside review of its cardiac catheterization lab, one of the most prolific heart-treatment centers in the U.S.

Valentin Fuster, director of Mount Sinai Heart, said he called for the review after a March 6 Bloomberg News article that raised questions about how the cath lab gets its patients caused him “some distress.” Doctors perform 17,000 procedures a year at the cath lab, including implanting cardiac stents into arteries to improve blood flow.

The story cited internal correspondence that said Mount Sinai patients who had appointments at the cath lab were directed to show up at the hospital’s emergency room -- and some were told to complain of urgent symptoms -- possibly to gain insurance coverage. The practices call into question whether the cath-lab procedures were appropriate, according to Sinai staffers who asked not to be named because they weren’t authorized to speak about hospital procedure.

Although he thinks the cath-lab work is good, “I want some outside people to look at quality,” Fuster said.

Mount Sinai documents cited in the story showed New York-area doctors who have financial arrangements with the hospital -- such as leasing office space for Mount Sinai’s use -- refer patients to the cath lab at 15 times the average doctor who send patients there.

Emergency-Room Review

While Mount Sinai’s leadership was reviewing issues related to the emergency-room allegations, the hospital hasn’t discovered any “systematic issues with regard to the appropriateness of quality-of-care” and “does not ever support or condone misrepresentation of patient symptoms,” according to e-mailed statements it provided in December. It has said its relationships with one referring doctor mentioned in the article were appropriate.

Fuster declined to detail the scope or timing of the review, beyond saying it would focus on cath-lab quality, and would be aimed at getting to the bottom of the situation.

Cath labs thread wires and tubes into blood vessels to implant stents in a procedure that brings about $20,000 per patient to hospitals and is among the most lucrative in medicine. The use of the small, metal-mesh stents in stable patients has been contentious in cardiology, with studies finding the devices are no better than drug-centered treatment in preventing heart attacks or death.

After the review, “if there is something, I’m going to know about it.” Fuster said in an interview. “And if there isn’t anything, I’m going to know about it.”

Outside Perspective

Fuster was interviewed at an American College of Cardiology conference in Washington, where he conducted a symposium on clinical research on March 30. He is a former president of the American Heart Association and is due to take over this year as the editor of the Journal of the American College of Cardiology, the specialty’s leading research publication.

Samin Sharma, the stenting specialist who runs the Mount Sinai cath lab and was also at the cardiology meeting, declined to comment on the outside review.

“That’s up to Dr. Fuster,” he said. “The emergency room should be kept for emergency patients.”

During a conference last summer, Kenneth Davis, Mount Sinai’s chief executive officer, singled out stenting doctors, also known as interventional cardiologists, for receiving “obscene levels” of pay. He has declined to explain his remarks further. Sharma made $4.8 million last year, including a raise he received after another New York hospital offered him a position, according to Mount Sinai.

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