Doctor’s Spinal Fusion Surgery Record Raises Questions

A Portland, Oregon neurosurgeon is facing scrutiny for the high number of spinal fusion surgeries he performs. According to The Wall Street Journal, Dr. Vishal James Makker has been named in a number of <"">medical malpractice lawsuits filed by patients who claim he performed unnecessary spinal fusion surgery on them. The doctor has also faced disciplinary action in the past for performing allegedly unnecessary spinal fusion surgery.

The Journal honed in on Makker as part of its investigation of Medicare databases to uncover fraud. The databases contain a computerized record of every bill submitted to, and paid out by, Medicare.

According to the Journal, the Medicare databases show that Makker performed 61 spinal fusions on patients enrolled in the federal healthcare program in 2008 and 2009. He performed a total of 24 additional fusions in 16 of those cases. “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,” the Journal said. Among other things, the Medicare data showed that Dr. Makker performed seven separate spinal fusions on one patient in less than two years. Five more of his Medicare patients had three separate spinal fusions.

According to the Journal, such spinal fusion surgeries are expensive and controversial:

“Some spinal surgeons contend the procedure is used too much, to treat conditions for which it isn’t effective, because it can be lucrative for surgeons and medical-device makers. While doing a second fusion surgery isn’t uncommon, these surgeons say, conducting multiple fusions on the same patient in a short period of time, except in cases of a spinal infection or cancer, isn’t good practice.”

The Journal investigation also found that the Oregon Medical Board has been aware Makker’s prolific record of spinal fusion surgeries. In 2006, the board cited him for performing “medically unnecessary” spinal fusions on patients without their consent. It also found that he provided inadequate follow-up care to those patients, and in some case billed for procedures he never performed. Makker agreed to complete remedial training program and billing course, but did not admit any wrongdoing, the Journal said.

Eight of Makker’s spinal fusion patients have sued him for malpractice in less than nine years of practice. According to the Journal, the average for neurosurgeons nationwide is about one suit every two years.

Unfortunately, prospective patients rarely know about controversial doctors like Makker, even though regulators may be aware of their questionable track records. Although some state medical boards have begun publicly releasing more information about problem doctors, much remains unavailable to the general public, the Journal said. The information in the Medicare database is kept strictly confidential, and The Wall Street Journal only was able to access it under severe restrictions. The paper’s publisher is in the process of trying to overturn a three-decade-old court ruling that bars the public release of this information.

The Wall Street Journal used the data it did access from the Medicare database to find unusual patterns of care by some doctors. The Journal said its investigation shows that information from the database could be to screen for potentially bad or negligent doctors by identifying suspicious patterns of care.

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