A recent review of unnecessary cardiac stent procedures at Maryland’s St. Joseph Medical Center by the Senate Finance Committee suggests that hospitals should review their peer review procedures and carefully consider how they develop quality of care review parameters, which should include volume and medical necessity factors.

In the St. Joseph case, a “physician often implanted cardiac stents without clinical indication and many may have been medically unnecessary.” Due to a failure of the Hospital’s peer review process, the Senate Finance Committee concluded that St. Joseph was unaware of the problem until it received a patient complaint. The Maryland Office of Health Care Quality found that the ‘‘hospital’s peer review process permitted the involved physician, as Chair of the Cardiology Department, to select the cardiology cases, including his own, for peer review.’’ This likely precluded the quality of care issue from being detected. Hospitals should assure that their peer review practices include independent, blinded review of providers and ensure that clinical heads are neither selecting nor reviewing their own cases. The Maryland Department of Health and Mental Hygiene also recommended in a recent report that hospital peer review processes include review of the volume and medical necessity of care to prevent unnecessary procedures.

The spotlight clearly is on potentially improper use of stents by physicians and hospitals, especially given the manufacturer’s active encouragement of the involved physician’s utilization of the manufacturer’s products. It is likely that hospitals with higher than average cardiac stent procedure rates will be scrutinized.

The report also indicated that the Committee was concerned about St. Joseph’s decision to limit the scope of its review of patient records to exclude those implanted with stents before a certain date.