The Cardiac Gloves Come Off!

Why is your heart the punching bag?

My cardiologist is just as good as yours.

On the way to my gym on Shelbyville Rd., I noticed a billboard advertising Baptist Health’s cardiology service.  It advises me that “some of the best cardiologists around don’t practice downtown.”  This, of course, is true.  The ad is an obvious riposte to some of the advertisements of downtown hospitals, one of which advised that for your best chance of surviving a heart attack, you should take the next exit.  If corporations are people, it is now getting personal!

It’s hard not to notice that our area hospitals advertise their cardiac services heavily.  Each one is said be the better for you, and amazingly, many can produce reports from external review organizations appearing to back up their assertions.  What is distinctly lacking, in my opinion, is objective evidence in the promotional material to support claims of excellence.  For most of the Fall and Spring of 2008-09, I drove several times a week past the sign (and the exit) on Interstate 65 that promised my best chance of surviving a heart attack.  I wondered on what basis the hospital could make such a claim.  When I learned that Medicare’s Hospital Compare was then calculating risk-adjusted mortality following heart attack, I had to check it out.  In fact, not only did the advertising hospital not have the best survival rate in the city, it had the lowest.  Nevertheless, the sign stayed up for many months.  Today the mortality rates have evened out, but is all such advertising so much puffery?  How are we to know?

Why are cardiology patients fought over?

It is not a state secret why cardiology, cancer, orthopedics, or neurosurgery are advertised so heavily by hospitals. These are among hospitals’ most profitable services. My former hospital lobbyist colleagues were quite open in admitting that cardiology services are overpaid by Medicare and other insurance companies.  According to the bank robber Willie Sutton’s law of medicine, that’s where the money is. I will say more about this in another post because an absence of profitable services is relevant to the financial difficulties of Louisville’s University Hospital.  In my opinion, the other downtown hospitals have helped to keep University Hospital in its place.

The Baptist billboard is clever, and reminds me of the series of billboard ads for hotdogs and whiskey also containing witty one-liners that we all chuckle at.  I would not be surprised if the same advertising agency was responsible for some of the medical ads as well. That is, a very depressing thought however.  At a time when food and dietary supplements are marketed as though they were medicines, medicine is marketed as though it was soap powder.  Are we really that gullible or so easy to manipulate?  I have already told you how I feel about the quality and ethics of some of these advertising campaigns.  If you believe everything you see and hear, you will be badly served.

The way things are now, if I want to know things like what percentage of cardiac revascularization procedures are complicated by wound infection, I do not know where to look.  This stuff is important.   In a 1995 study of mine, 60% of hospitals in Kentucky did fewer than one mastectomy for cancer a month: 21 hospitals did 3 or fewer in a year.  Additionally, if the data are to be believed, almost half of the physicians who perform mastectomies for cancer did two or fewer procedures per year.  Would you want to go to a hospital or doctor with so little experience if you have a choice?  Would you go to a Louisville hospital if you knew it was the only major hospital in the state that was still doing discredited radical mastectomies?  I wouldn’t.  If such information was available, the medical world would be rapidly shamed into getting its act together.  I’d like to see that happen, but don’t hold your breath.  That is why I think we deserve to have access to hospital- and physician-specific information about experience and results.  A layperson will indeed have trouble interpreting the data, but there will be plenty of people around to help.

So how is the average person supposed to navigate this market?  I don’t have an easy answer for you.  Even as a professor of medicine, I can’t tell one hospital apart from another by their advertisements except that I hate some of the ads more than others.  The advice I have always given my patients and friends is that they should go where their trusted primary physician suggests.  Frankly, that is what I do.  In the new era of hyper-competitive medicine in which physicians are employees of the health systems, I fear my advice is not as sound as it used to be.  Do you really think that a physician employee of X-Hospital would or could send you to Y-Hospital for a service that both hospitals performed, even if that physician thought it would be better for you?  I’d like to think they would, but I guarantee you it will not happen every time.

Peter Hasselbacher, MD
Feb 18, 2012