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Cardiologists: The More You Document, the Less Scrutiny You’ll Endure

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Take a guess: which specialty would you say is the most scrutinized?

We’ll wait.

Okay, time’s up.

Did you guess cardiology? Because if you did, you guessed correctly.

In fact, it’s tough to be a 21st century cardiologist, Joe Carlson writes over at Modern Healthcare’s blog. You’re being scrutinized more closely than fans scrutinize the latest Star Wars movie for canon violations. Furthermore, the documentation required from you is incredible and some would say, borderline ridiculous.

But, Carlson continues, “there’s reason for the greater oversight.”

According to experts, “Cardiovascular care consumed more than 16 percent of Medicare spending in 2010, and costs have grown faster than in other specialties because of cardiology's rapid adoption of new procedural techniques and diagnostic testing equipment.”

Hence, the scrutiny; and hence, the paranoia.

Dr. Spencer King, cardiologist at the Atlanta-based Heart and Vascular Institute, said, “The physicians are becoming dramatically aware of this kind of supervision. Some of them are becoming paranoid about it. But they really shouldn't be concerned about prosecution or anything if they are providing the care that they said they are providing, and if the (clinical) evidence is there.”

The government is primarily zeroing in on the placement of stents, Carlson reports, an area that has produced the greatest amount of profligacy on the part of cardiologists, so much profligacy that “federal regulators now routinely insist on 70 percent stenosis, or coronary blockage, to justify the use of a wire mesh to prop open a blood vessel.”

How can cardiologists and physicians in general keep their arteries unclogged from federal intrusion?

The answer is pretty simple actually. “Follow the clinical guidelines published by professional societies.”

Then, document that you’re following those rules.

And document some more.

And keep documenting.


As King observed, “Physicians are becoming increasingly aware that they are being watched, and this is driving a great interest in recordkeeping, a great interest in electronic medical records. It's going to be very difficult to prove fraud for something that is thoroughly documented.”

Okay. So, you’re a cardiologist looking for a job. How would you answer questions related to this scrutiny in a job interview? What do you do to ensure that you’re not wasting money? How much do you document your work? Which procedures do you think are the most wasteful?

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