Portland Neurosurgeon Continues To Be Poster Boy for Misaligned Incentives

Today’s Managing Health Care Cost Indicator is $519,674.35

Yesterday’s Wall Street Journal  had another chapter in the sad saga of Vishal Makker, a neurosurgeon in Portland, Oregon  identified by WSJ as having the highest rate of multiple spinal surgeries on individual patients in the entire country. His rate of repeat surgery is 10 times the national average. He has performed as many as seven spinal fusions on a single person.  

Here’s the update
-        He’s been booted off the local hospital's medical staff.   (One more victory for transparency!)
-        The state medical board has launched an investigation, apparently with the FBI
-        He received over a half million dollars from a spinal implant supplier (Omega) over a 16 month period. This apparently represents 25% of the revenues from supplies for his surgeries with the company’s products.
-        The Omega product representative in Portland is allegedly Dr. Makker’s girlfriend

The WSJ has also posted a letter from a consultant from Omega, promising not only these payments, which are highly likely to be viewed as illegal kickbacks, but also promising to refer workers compensation patients to physicians participating with him.   

Physician self-referrals are an ongoing cause of increased cost, potential patient harm, and downright embarrassment to the medical community.   It's time the American Medical Association implements meaningful ethics rules - and if they don't, government will.  It's also a tangible reason why the Medicare claims database should be made available to researchers and journalists with physician identifiers. In this instance, identifying the physician is likely to lower medical cost and improve the public's health. 

Here are a few other posts on the issue of physician self-referral: