Several hospitals in California, Nevada and Arizona have engaged the services of an outside independent auditing firm to impartially evaluate whether recent cardiovascular procedures were medically necessary and appropriate. The protocols were implemented to provide assurance to their communities and patients that the administration, medical staff and interventional cardiologists of the hospitals were dedicated to giving the highest quality of care.
Physician Compliance Network (PCN) of Los Angeles performed the audit, launched by a group of cardiologists with the mission of improving the quality of cardiovascular care by increasing the adherence to evidence based medicine and established guidelines. PCN utilized a proprietary system of unbiased, external peer review to help administrators and medical executive committees at hospitals identify and correct any potential problems. The review process systematically evaluated cardiac procedures for medical necessity according to American College of Cardiology (ACC) recommendations.
Over the last decade, the U.S. government investigated several hospitals for billing medically unnecessary cardiac procedures. The most publicized scandal occurred at a Tenet-owned hospital in Redding, Calif., in which hundreds of unnecessary PCI and CABG procedures were performed. These events demonstrated that some of the current procedures for medical staff peer review were outdated and inadequate to protect the welfare of patients, according to PCN.
Several of the hospitals that participated in the auditing process reported that the findings and recommendations provided by PCN resulted in a better assessment of coronary blockages and a reduction in the number of costly and unnecessary interventions. To date, PCN said that it has reviewed thousand of PCIs for medical necessity.