The Boston Globe on Wednesday examined how public reporting of procedure-specific death rates for different hospitals could be "pushing Massachusetts cardiac specialists to treat some very sick heart patients less aggressively, sparking a debate among health officials and doctors over whether patients are being spared unnecessary and costly end-of-life treatment or denied procedures that might save their lives." State health officials cited Massachusetts General Hospital and St. Vincent Hospital for above-average death rates last year in patients undergoing angioplasty. Cardiologists at MassGen in a January letter acknowledged that in 2008, they performed angioplasty on a "relatively large number of patients with little hope of survival," and said that "we needed to modify our practices." Officials welcomed the change of policy, noting that treating patients with little hope of recovery "wastes money and exposes them to unnecessary care and pain," according to the Globe.

However, cardiologists say that "decisions about who should undergo angioplasty are frequently not so clear," the Globe reports. In situations where patients arrive at a hospital while having a heart attack, doctors say they are concerned that colleagues could decide not to perform angioplasty to avoid a potential bad outcome that would hurt the hospital's reputation. Frederic Resnic, director of cardiac catheterization at Brigham and Women's Hospital, said, "Physicians are really struggling with this issue." He added, "There is a terrible conflict between the desire to do what's right for a specific patient who has a very slim chance of survival, and the impact on the (doctor) and their center if it doesn't work out." He noted recent studies that suggest that public reporting of outcomes may be influencing doctors in the state and nationwide to decide against treating higher-risk patients.

Doctors say that a major component of the issue is that the state fails to adjust completely for how ill patients at each hospital are when calculating whether death rates are excessive. Massachusetts Public Health Department Director of Health Care Safety and Quality Paul Dreyer said the state has one of the best methods in the nation for determining how sick patients are before a procedure, and how likely they are to survive it. However, he said the controversy over death rates at the two hospitals is leading state officials to work with doctors to account for additional risk factors when figuring mortality rates (Kowalczyk, Boston Globe, 4/1).

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