Weight-Loss Surgery Scandal; Unnecessary Vascular Surgeries; Private Equity Probe

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Bariatric Surgery Assembly Line?

Bellevue Hospital, a large public hospital in New York City that serves a predominantly lower income population, has a robust bariatric surgery program. However, according to a New York Times investigation, the hospital “has become a high-speed assembly line that has endangered some patients and compromised urgent care for others.”

Last month, the program had a fashion show with former bariatric patients modeling their thinner post-surgery bodies. The hospital has a lot of patients to choose from for the event, since it churns out thousands of surgeries per year.

This year alone, Bellevue is on track to perform 3,000 surgeries, which the Times estimates would earn the hospital upwards of $34 million. One in five surgeries at the hospital are for weight loss, and the Times found that other procedures and patient care often has to work around the dominating schedule.

Sometimes there are so many bariatric surgeries happening in the OR that non-life-threatening cases like minor stab wounds, broken bones, or detached fingers wait hours, a dozen employees verified. Multiple employees also confirmed that two surgeons regularly race to see which can complete more surgeries in a day.

Many of the patients who get the surgery aren’t necessarily good candidates, either, according to the Times. Weight-loss surgery is an intensive procedure that requires weeks of pre-op preparation, and those who get it commit to a lifetime of altered eating behavior. Multiple people in jail on Rikers Island have had bariatric surgery at Bellevue despite not having the agency to stick to the high-protein diet and eating intervals recommended. Some have had long-term health consequences, including malnourishment, as a result, per the Times.

Too Many Vascular Surgeries?

A sliver of doctors — around 200 — have conducted nearly 200,000 atherectomies in a 5-year period, earning them $1.5 billion in reimbursements. But many of the people getting the procedure might not need it, according to ProPublica.

Atherectomies are treatment for severe vascular disease, but mild cases should first be treated with medicine and exercise. An analysis by ProPublica found that since 2019, a quarter of people who had the procedure were only diagnosed with claudication, which indicates early-stage disease. ProPublica deduced that 30,000 patients may have unnecessarily had the procedure in recent years.

When whistleblower Caitlin Hicks, MD, warned of exploitation of these profitable surgeries, she faced immense pushback, according to another article in the outlet’s “Arterial Motives” series.

The doctors who responded to ProPublica‘s inquiries also pushed back. For instance, Amiel Moshfegh, MD, has been reimbursed nearly $46 million for more than 7,000 atherectomies in the past several years. He’s received the most reimbursements in the whole country for the procedure by nearly double.

“Atherectomies ultimately can save the government and taxpayers millions of dollars by avoiding amputations,” Moshfegh told ProPublica.

Moshfegh, who is based in Los Angeles, travels to nearby Bakersfield every week to do the procedure, according to staff at the clinic. Many of his referrals come from a few podiatry offices, one of which shares office space with a vascular clinic that Moshfegh is not officially associated with but he does appear in their marketing.

Private Equity Under Investigation

The Senate Budget Committee launched a bipartisan probe into the impact of private equity ownership of hospitals, citing concerns that these deals are bad for doctors and patients, according to STAT.

Committee chair Sen. Sheldon Whitehouse (D-R.I.) said the acquisitions follow a pattern. First, private equity buys a hospital, “saddles it with debt,” then ultimately cuts services and staffing while making a pretty penny.

“Before the dust settles, the private equity firm sells and leaves town, leaving communities to pick up the pieces,” Whitehouse said.

Ranking member Sen. Chuck Grassley (R-Iowa) had opened a probe into Iowa hospitals last March, and now asks questions that went unanswered in his original query to private equity hospital ownership there.

Previous STAT investigations have revealed how private equity firms, including Welsh, Carson, Anderson & Stowe, “ruthlessly chased profits by exploiting loopholes and government programs in niche areas of the healthcare industry.”

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