From today's Wall Street Journal (online edition)
HEALTH INDUSTRY APRIL 13, 2011.
Hospital Bars Surgeon From Operating Room
Medical Board in Oregon Separately Investigates Doctor Who Stood Out for High Rate of Multiple Spinal Procedures.
By JOHN CARREYROU And TOM MCGINTY
A Portland, Ore., neurosurgeon who performed multiple spinal fusions on the same patients lost his operating privileges at the hospital where he did many of his surgeries and is under investigation by the Oregon Medical Board.
Providence Portland Medical Center revoked Vishal James Makker's surgical privileges last week following a March 29 article in The Wall Street Journal that identified Dr. Makker as having the highest rate of multiple spinal-fusion surgeries among 3,407 surgeons who performed the procedure on 20 or more Medicare patients in 2008 and 2009.
Dr. Makker's rate was nearly 10 times the national average, a Journal analysis of Medicare claims data showed. Dr. Makker, who operated on some of his patients' spines as many as seven times, last month denied wrongdoing and said he acted in the best interest of his patients.
Oregon's medical board has also opened an investigation into Dr. Makker, according to two people familiar with the matter. One of these people was recently interviewed by board representatives and Federal Bureau of Investigation agents as part of the probe. The FBI didn't return a call for comment. Dr. Makker's lawyer declined to comment.
The Oregon board forced Dr. Makker to undergo remedial training in 2006 for what it called unnecessary surgeries and for allegedly billing for procedures he didn't perform, but his status is listed as active on its website. A malpractice lawsuit—the ninth in less than seven years—was filed against Dr. Makker last week.
A spokesman for Providence Portland declined to say why it withdrew his privileges.
The latest developments came as new information emerged about the medical-device distributorship that supplies Dr. Makker with spinal implants. The distributor, Omega Solutions of Fresno, Calif., sometimes pays surgeons to use its products, according to a document reviewed by the Journal that Omega recently sent to surgeons it sought to recruit.
The document says that the company enters into partnerships with surgeons who agree to use its products and pays them "dividends" based on the number of surgeries they perform. Critics say such arrangements are controversial because they can skew medical decision-making.
The document details the cash payments made to one of Omega's partners, an unnamed spine surgeon in Los Angeles. From Jan. 1, 2009, to May 19, 2010, the surgeon received a total of $519,674.35 based on his use of Omega implants in two to three surgeries a week, the document says.
Dr. Makker told colleagues at Providence Portland Medical Center that he was a partner in Omega's business, according to a person familiar with the matter. Through his lawyer, Dr. Makker denied this.
Ted Switzer, the chief executive of Omega, said the company wasn't involved in a partnership with Dr. Makker that paid him to use its products, and declined to answer any other questions. Robert Zendejas, the Omega employee whose name is on the company's marketing document, hung up on a reporter when reached by phone.
Physician-owned distributorships, or PODs, such as the ones outlined in the Omega document have spread through spine-surgery circles. Distributorships act as middlemen between medical-device makers and the hospitals and surgery centers that buy their products. In exchange for marketing the devices and nurturing client relationships, they get a cut of each sale.
For a distributorship, winning the allegiance of surgeons is crucial because surgeons often dictate to their hospitals which devices to buy. By offering surgeons an ownership interest in their operations, distributorships can lock up a hospital's business while allowing the surgeon to profit from each device he uses, according to people familiar with how PODs function.
Critics say such deals have contributed to a jump in spine surgeries. Spinal fusion, which involves fusing together two or more vertebrae with the help of thousands of dollars of hardware, went from costing Medicare $343 million in 1997 to $2.24 billion in 2008, according to a Journal analysis of Medicare claims data.
The Office of Inspector General of the Department of Health and the Centers for Medicare and Medicaid Services have both warned that PODs may violate federal antikickback statutes and laws governing patient referrals.
Mr. Switzer, the Omega Solutions CEO, is listed in California corporate records as a partner in a half-dozen limited liability companies named after letters in the Greek alphabet. Asked whether they are PODs, Mr. Switzer declined to comment.
Dr. Makker's use of Omega implants raised eyebrows at Providence Portland Medical Center because Omega's product representative in Portland, Erin Martinson, is Dr. Makker's girlfriend, according to three people with knowledge of their relationship. Ms. Martinson was often present in the operating room with Dr. Makker to hand him the Omega implants during his surgeries there.
Ms. Martinson didn't return phone calls. In an email last month, Dr. Makker denied having a romantic relationship with Ms. Martinson, saying she was merely a friend.
Write to John Carreyrou at john.carreyrou@wsj.com and Tom McGinty at tom.mcginty@wsj.com
Copyright 2011 Dow Jones & Company, Inc.
HEALTH INDUSTRY APRIL 13, 2011.
Hospital Bars Surgeon From Operating Room
Medical Board in Oregon Separately Investigates Doctor Who Stood Out for High Rate of Multiple Spinal Procedures.
By JOHN CARREYROU And TOM MCGINTY
A Portland, Ore., neurosurgeon who performed multiple spinal fusions on the same patients lost his operating privileges at the hospital where he did many of his surgeries and is under investigation by the Oregon Medical Board.
Providence Portland Medical Center revoked Vishal James Makker's surgical privileges last week following a March 29 article in The Wall Street Journal that identified Dr. Makker as having the highest rate of multiple spinal-fusion surgeries among 3,407 surgeons who performed the procedure on 20 or more Medicare patients in 2008 and 2009.
Dr. Makker's rate was nearly 10 times the national average, a Journal analysis of Medicare claims data showed. Dr. Makker, who operated on some of his patients' spines as many as seven times, last month denied wrongdoing and said he acted in the best interest of his patients.
Oregon's medical board has also opened an investigation into Dr. Makker, according to two people familiar with the matter. One of these people was recently interviewed by board representatives and Federal Bureau of Investigation agents as part of the probe. The FBI didn't return a call for comment. Dr. Makker's lawyer declined to comment.
The Oregon board forced Dr. Makker to undergo remedial training in 2006 for what it called unnecessary surgeries and for allegedly billing for procedures he didn't perform, but his status is listed as active on its website. A malpractice lawsuit—the ninth in less than seven years—was filed against Dr. Makker last week.
A spokesman for Providence Portland declined to say why it withdrew his privileges.
The latest developments came as new information emerged about the medical-device distributorship that supplies Dr. Makker with spinal implants. The distributor, Omega Solutions of Fresno, Calif., sometimes pays surgeons to use its products, according to a document reviewed by the Journal that Omega recently sent to surgeons it sought to recruit.
The document says that the company enters into partnerships with surgeons who agree to use its products and pays them "dividends" based on the number of surgeries they perform. Critics say such arrangements are controversial because they can skew medical decision-making.
The document details the cash payments made to one of Omega's partners, an unnamed spine surgeon in Los Angeles. From Jan. 1, 2009, to May 19, 2010, the surgeon received a total of $519,674.35 based on his use of Omega implants in two to three surgeries a week, the document says.
Dr. Makker told colleagues at Providence Portland Medical Center that he was a partner in Omega's business, according to a person familiar with the matter. Through his lawyer, Dr. Makker denied this.
Ted Switzer, the chief executive of Omega, said the company wasn't involved in a partnership with Dr. Makker that paid him to use its products, and declined to answer any other questions. Robert Zendejas, the Omega employee whose name is on the company's marketing document, hung up on a reporter when reached by phone.
Physician-owned distributorships, or PODs, such as the ones outlined in the Omega document have spread through spine-surgery circles. Distributorships act as middlemen between medical-device makers and the hospitals and surgery centers that buy their products. In exchange for marketing the devices and nurturing client relationships, they get a cut of each sale.
For a distributorship, winning the allegiance of surgeons is crucial because surgeons often dictate to their hospitals which devices to buy. By offering surgeons an ownership interest in their operations, distributorships can lock up a hospital's business while allowing the surgeon to profit from each device he uses, according to people familiar with how PODs function.
Critics say such deals have contributed to a jump in spine surgeries. Spinal fusion, which involves fusing together two or more vertebrae with the help of thousands of dollars of hardware, went from costing Medicare $343 million in 1997 to $2.24 billion in 2008, according to a Journal analysis of Medicare claims data.
The Office of Inspector General of the Department of Health and the Centers for Medicare and Medicaid Services have both warned that PODs may violate federal antikickback statutes and laws governing patient referrals.
Mr. Switzer, the Omega Solutions CEO, is listed in California corporate records as a partner in a half-dozen limited liability companies named after letters in the Greek alphabet. Asked whether they are PODs, Mr. Switzer declined to comment.
Dr. Makker's use of Omega implants raised eyebrows at Providence Portland Medical Center because Omega's product representative in Portland, Erin Martinson, is Dr. Makker's girlfriend, according to three people with knowledge of their relationship. Ms. Martinson was often present in the operating room with Dr. Makker to hand him the Omega implants during his surgeries there.
Ms. Martinson didn't return phone calls. In an email last month, Dr. Makker denied having a romantic relationship with Ms. Martinson, saying she was merely a friend.
Write to John Carreyrou at john.carreyrou@wsj.com and Tom McGinty at tom.mcginty@wsj.com
Copyright 2011 Dow Jones & Company, Inc.
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