Tag Archives: surgery

Laser spine clinics use Internet search ads to push unproven, costly treatment

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Bloomberg’s David Armstrong has put together an investigation of a simple, effective and dubious new business formula, one which begins with pain in the back. In thousands of patients, this chronic back pain leads to desperation, desperation leads to Internet searches, and Internet searches lead to rosy-sounding ads for laser spine treatments from the fast-growing, high-priced, high-volume clinics that are blossoming around the country. google-back-pain

According to Armstrong, this trend is epitomized by Laser Spine, the six-year-old industry leader with $109 million in sales last year and a monster profit margin of 34.3 percent from 2006 to 2009. It typically charges about $30,000 per procedure, or about half of what any insurer would be willing to pay for a garden-variety laser-free surgery.

Laser Spine and its competitors, part of a boom in outpatient clinics operated by entrepreneurial physicians, sell a high-tech version of procedures that have been around for years — despite a lack of independent research to show that their variations lead to better outcomes. The company commands higher prices than laser-less rivals, driving up the cost of health care. Its number of malpractice claims per 1,000 surgeries is several times the rate for all U.S. outpatient surgery centers, based on insurance industry data.

How do these companies get away with charging high prices for procedures with shaky track records? Through a gap in federal regulation that will be familiar to reporters who have investigated surgical robots and other high-tech procedures.

While the Food and Drug Administration regulates the use of drugs and medical devices, there’s virtually no federal oversight for the effectiveness of surgical techniques.

“This is an issue with surgery generally,” said Robert McDonough, head of clinical policy research and development at Aetna. “Surgeons can introduce new procedures that might be significantly different from established ones with no oversight of the claims they make.”

Drug-makers’ ads — including sponsored links that appear in response to search-engine queries — must disclose their medications’ risks, under FDA rules. Ads for surgical techniques have no similar rules.

Data: Calif. for-profits order more C-sections

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Writing for California Watch, Nathanael Johnson leads with the numbers on his story about for-profit hospitals and C-sections. Appropriately for a story based on a hand-built database, classic health anecdotes don’t even surface until after the 20th paragraph. Instead, readers are immediately hit with this:

A database compiled from state birthing records revealed that, all factors considered, women are at least 17 percent more likely to have a cesarean section at a for-profit hospital than at one that operates as a non-profit. A surgical birth can bring in twice the revenue of a vaginal delivery.

It’s a powerful and nuanced – if not unexpected – finding. Johnson digs deep in the numbers, and hits on a litany of confounding factors and caveats. In the end, some of his most surprising findings were that patients at for-profit hospitals in poorer areas of Los Angeles were the most likely to receive C-sections, and that variation in these surgeries can be attributed to everything from cultural differences, patient preferences and even a desire to avoid malpractice suits.

How Johnson put it all together

For health journalists, the most exciting part of the entire package is likely Johnson’s detailed “how I did it” sidebar. He talks about how he chose which data to pursue, how he created the database behind the story, and even which specific Excel functions he used to find meaning within the numbers. Of particular interest are the sections in which he lists the sources he used to help him understand what he was seeing within the numbers, and to guide him toward his subsequent conclusions.

Outpatient care can lead to more infections

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

With a nod to the established dominance of outpatient surgery, NPR health blogger Scott Hensley explores a recent JAMA study which demonstrates that outpatient, same-day surgery carries with risks of infection that Hensley said were “a lot higher than they should be.”

Random inspections of nearly 70 surgery centers in three states found that two-thirds had at least one significant lapse in controlling infections. One common problem was the use of single-dose medication vials for more than one patient — found in 28 percent of the inspections.

Quite a few stakeholders have thoughts on the study, starting with a companion editorial by surgery professor Philip S. Barie (bio). The relevant trade group has also produced a response, as has HHS Secretary Kathleen Sebelius. Both say about what you might expect. The industry group says that an industrywide infection clampdown and new CMS standards for such activities have helped control the problem in the time since the study’s data was collected, and Sebelius trumpets current and future HHS efforts to avoid as many health-care-associated infections as possible.

Taken from an industry group report, this graph shows at a glance exactly why outpatient surgery is such a significant issue.

Study prompts hospital CEO to blog about change

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

A study led by Harvard researchers and published in the New England Journal of Medicine found that hospitals that used a safety checklist before, during and after surgery experienced fewer deaths and complications.

Atul Gawande, M.D., senior author of the paper and a surgeon at Brigham and Women’s Hospital, told The Boston Globe that the results were “beyond anything we expected.”

According to the Globe:

“The checklist is based on World Health Organization guidelines and takes only a couple of minutes to complete. It requires operating room staff to complete a series of verbal steps before giving the patient anesthesia, before the incision, and before the patient leaves the operating room.”

Paul Levy, president and CEO of Beth Israel Deaconess Medical Center in Boston, blogged about the study and says he is frustrated about the failures in the medical system to make changes “in a profession that is so steeped in the practice of giving individual physicians the prerogative to do their work the way they want to.”

Gawande is scheduled to speak Feb. 11 in a lecture that will be broadcast online as part of the NIH Director’s 2008-2009 Wednesday Afternoon Lecture Series. The topic of his lecture is “Ignorance vs. Ineptitude: Science and the Causes of Failure in Medicine.”