The WSJ Is Excellent On Bad Doctors

Using a Medicare database to find outlying surgeons

The Wall Street Journal has been mining a massive Medicare database for an investigative series on Medicare—particularly its costs and abuses and how they reflect problems in the health care system in general. Today it adds a tough page-one story on how the data can help identify bad doctors.

The paper has had to agree not to name doctors in order to use the database, and it’s suing the government to change that. But for today’s story, John Carreyrou and Tom McGinty focus on a Portland neurosurgeon whom they all but say is performing unnecessary multiple surgeries on patients, and they get to name him because he let them do so. That makes this even more of a highwire act:

Medicare database analyzed by The Wall Street Journal reveals that Dr. (Vishal James) Makker has had an unusual propensity for performing such multiple surgeries on the spine. The data show that in 2008 and 2009, Dr. Makker performed spinal fusions on 61 Medicare patients. In 16 of those cases, he performed a total of 24 additional fusions. That gave him an overall rate of 39 additional fusions per 100 initial fusions, the highest rate in the nation among surgeons who performed spinal fusions on 20 or more Medicare patients during those two years.

And it’s clearly not just a Medicare problem, but a private-health insurer one, too. The paper reports Medicare reimbursed Makker for just 11 percent of his billings.

The Journal says this about the database it used to find Makker:

Analysis of the data suggests that it also could be used as a tool to help screen for potentially bad or negligent doctors by identifying suspicious patterns of care.

And it gives us another anecdote, this one for somebody who understandably didn’t want to be named:

For instance, the data reveal that a foreign-born surgeon currently operating in Texas has an unusual number of patient deaths associated with an elective procedure. The surgeon was excluded from both the Medicare and Medicaid programs for nine years in the 1990s after the Office of Inspector General of the Department of Health concluded that he had performed unnecessary and inappropriate procedures on seven patients while practicing in New Jersey. In two of the cases, the surgeon inappropriately operated on patients who were nearly dead, and he contributed to a third patient’s death by misdiagnosing his condition, according to a letter the inspector general sent him when he was ousted from Medicare. He was temporarily barred from practicing in New Jersey.

The surgeon relocated to southern Texas in 2005. He currently operates at five hospitals there. In 2008 and 2009, nine of 49 Medicare patients on whom he performed an elective surgery died, three of them within days of the operation, according to the Medicare data. That equates to 18.4 deaths per 100 of the procedures, compared with a national average of 2.4 per 100 for the procedure.

It’s unclear why the WSJ doesn’t tell us what kind of elective surgery this doctor is engaged in. I might want to know if I were having something done in, say, Houston. Perhaps the Journal thought that naming the surgery might make it possible to effectively identify the doctor. It would have been good to name the surgery or explain why they couldn’t do so.

But that’s just a quibble. This story is a classic WSJ leder. I love the detail here and that the Journal clearly did a deep dive on this guy. That helps them give us an idea of how quickly Makker got very rich doing back surgeries:

Dr. Makker, who drives a sporty black Mercedes with “J MAK” vanity plates, attended medical school at the University of Texas Health Science Center in San Antonio and did his neurosurgery residency at Rhode Island Hospital in Providence. When he completed his training in 2002, he moved to Portland.

Dr. Makker quickly built a busy surgical practice. By July 2005, his net worth was $8.7 million, according to a document filed in court when he and his wife divorced in 2008. Dr. Makker estimated in a legal deposition in a separate proceeding that he performs between 300 and 500 spinal surgeries a year…

Cathi Crandall, a 47-year-old photographer, said Dr. Makker could be very persuasive about having additional surgery. Ms. Crandall, who has not sued Dr. Makker, had three spinal surgeries with him in less than 18 months. She says she decided to halt treatment with him when he tried to persuade her to have a fourth. She likened him to “an Academy Award winning actor,” adding: “It’s as if he’s charming you to go on a date, except the date is going to involve a surgery.”

Doctor pay seems to be an almost untouchable factor in health care costs, but come on now. This guy put aside $3 million a year (I should note that it’s possible he had preexisting sources of wealth) doing back surgeries—and he’s clearly not somebody on the best-doctor lists. Ezra Klein noted back in 2008 that a McKinsey study found that the U.S. pays its doctors $58 billion a year more than Europe does. (Also fascinating: The study found that compared to Europe, we overpay for drugs by $66 billion and $50 billion for underwriting and marketing, plus we tack on $75 billion for industry profits).

In this case, the story is a devastating picture of a doctor on the far end of the spectrum. But the Journal found fifty spinal surgeons whose rate of additional fusion procedures on the same patient is at least quadruple the average rate (see its chart). The prospect of using this kind of computer-assisted reporting to smoke out bad doctors and perhaps to retrain or rein in the less egregious ones is fascinating. There are surely many, many more stories to be found.

Excellent work by the Journal.

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Ryan Chittum is a former Wall Street Journal reporter, and deputy editor of The Audit, CJR's business section. If you see notable business journalism, give him a heads-up at Follow him on Twitter at @ryanchittum. Tags: , , ,