Watch how the pursuit of profit and volume endangered patients and drove a reputable liver transplant program into the ground.
The WSJ writes recounts the fascinating story of a surgeon hired primarily to increase the volume of surgical procedures at the University of Pittsburgh, priced at almost half a million per transplant. For those who can’t access the WSJ, go and read Jeffrey Parks’ summary.
By taking short-cuts to increase the availability of livers, patients were endangered. Some “didn’t need a transplant,” and others were “dying on the operating table or in the ICU.”
This is revenue-driven medicine at its extreme.
topics: transplant, revenue
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- The risk and possible rejection of a face transplant
- CIGNA and the denial of a liver transplant
- Texting young liver transplant patients to take their medications
- Worrying about a miscarriage while performing a liver transplant
- The human head transplant
- Transplant tourism
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{ 2 comments }
CEO of a nonprofit earning $4 million and 13 other employees in the 1-2 million range?
Explain that please?
Never mind, I can.
GREED!
The topic of organ allocation and transplants seems to be one that has escaped from intense scrutiny and therefore has been utilized by some solely as a means of financial gain. I agree that the salaries cited for the hospital executives in the article do seem ridiculous and highly reflective of the priorities of these powerful individuals, but I would argue that the article raises the much more important question of quantity versus quality, a debate which remains central to the medical profession. Clearly, in this instance Dr. Marcos opted for quantity so that UPMC could make the greatest profit from transplant surgeries.
This goes to show that society cannot necessarily depend on the individual surgeon to make the correct decision about which patients need a transplant and which organs are acceptable, so we must advocate for a change in the system, most specifically in the manner in which doctors are reimbursed. Because the federal government and private insurers usually pay a flat rate for a liver transplant, a given hospital can make more money on those patients whose care costs less than the set rate, while it loses money by treating patients whose care costs more. This is the principal drive behind the unethical practices of Dr. Marcos—using livers from older donors which were rejected by other centers and performing live donor partial liver transplants while misrepresenting potential risks and complications. By only providing liver transplants to those with a MELD score of less than 14, signifying healthier patients, he was able to cut costs to the hospital and increase his own profits and prestige.
The problem with DRGs or fee for service reimbursement plans is that they give incentives for increasing quantity but lack any regulation on quality. If implemented, new pay for performance plans could help prevent this type of misuse of medical resources and power while increasing the focus on quality care for each individual patient. Rather than power based on volume, we could begin to see power based on outcomes and take a step towards ending the reign of medical economics over medical ethics.
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