You could draw me to any exposure and disgrace.

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While Charles Dickens is referring to the effects of the pressure that love can place on a person in Our Mutual Friend, the pressures of practicing clinical cardiology in the contemporary landscape could lead to equivalent exposure and disgrace, as this week’s news has shown.

In this era of increasing transparency, due to state and federal mandates, Massachusetts took the pressure to expose industry and physician relationships to another level. The state’s Office of Health and Human Services published all payments from pharmaceutical and medical device companies to physicians and healthcare providers in Massachusetts in an online database.

While a listing on this database does not infer any wrongdoing on the part of the physician or healthcare provider, it may inadvertently cause patients to question the motivations of the doctors. Therefore, many physicians still question whether transparency at all costs will result in a positive impact.

However, there is no doubt that interventional cardiology will continue to endure scrutiny due to the actions of Dr. Mark Midei, who received a federal hand-slap this week, and a great deal of public disgrace for his alleged overstenting. The Senate Finance Committee released a report detailing Midei’s case, who reportedly implanted nearly 600 potentially “medically unnecessary” stents from 2007 through mid-2009 at St. Joseph Medical Center in Towson, Md. The report also questioned his relationship with Abbott Labs, which paid more than $30,000 to Midei to help market the drug-eluting stent Xience V.

Finally, a new Health Affairs report is calling Medicare to terminate reimbursements for self-referred imaging procedures. According to the researchers, only 15 percent of self-referred high-tech imaging occurs on the same day as the physician's order, “calling into question any benefit from self-referral and the higher imaging rates.” If this recommendation is considered by cash-strapped CMS, it could have wide-spread damaging effects on independent cardiology practices, which are already struggling to make their financial ends meet.

However, the week showed promise that the financial pressures for those cardiologists treating Medicare patients may be alleviated, as the Senate took steps to prevent the 25 percent SGR cuts until at least Dec. 31, 2011. The legislation still has to be approved by the House.

On these topics, or any others, please feel free to contact me.

Justine Cadet