A third development may have had some influence as well. Last July, a report in the Journal of the American Medical Association used the American College of Cardiology's PCI registry and found that only 50% of a sample of such procedures met necessity criteria, 12% were indisputably unnecessary, and another 38% were uncertain.
Fonarow says that over the last several years, perhaps in response to "some of the earlier cases that were under scrutiny," hospitals, cardiology practices and professional societies have become proactive to assure the necessity of all procedures.
Sometimes, he says, hospitals will have a second interventional cardiologist review the films before allowing an interventionalist to proceed. Or, cases will be subject to subsequent peer review.
Some hospitals have decided to regularly select a random set of cases to send to a committee "to see if there's any concern and provide feedback, to make sure they're providing high quality, but also appropriate, care."
"You're seeing lot of hospitals doing that," he says.