Thread by @AnnieWaldman

NEW: Dr. Caitlin Hicks and fellow researchers warned that some doctors appeared to be overusing lucrative vascular procedures, needlessly exposing patients to risk of harm.

For her research, she was accused of "fratricide" and called a "nazi."

My latest: propublica.org/article/resear…

ProPublica has spent the past year investigating vascular procedures, and we've chronicled horror story after horror story of patients who lost their legs from complications after lucrative procedures. propublica.org/series/arteria…

We found that some doctors are making **millions of dollars** doing a questionable number of procedures, often in outpatient clinics, exposing patients to risks of harm, including amputation and even death. propublica.org/article/maryla…

In our reporting, one treatment has stood out:
Atherectomy procedures, which use catheters affixed with lasers or blades to pulverize plaque from vessel walls.

Even though research has indicated that atherectomies may not be more effective than other treatments – and experts warn they may be associated with a higher risk of complications – they remain unchecked because doing them remains easy and profitable propublica.org/article/resear…

We analyzed five years of public Medicare data, and found that a small group of doctors is responsible for a majority of atherectomy procedures and payments:

About 200 doctors earned nearly *$1.5 billion* in reimbursement for almost 200,000 procedures. propublica.org/article/thousa…

CMS, the agency that oversees Medicare, told ProPublica that it examines its billing data for outliers, taking action when it identifies problems by denying claims, suspending payments or referring questionable providers to law enforcement.

We wanted to understand more about how patients are being treated, so we worked with @CareSet data journos @FredTrotter + Alma Trotter to examine how often doctors are conducting vascular procedures on patients with more mild vascular disease: propublica.org/article/thousa…

While experts recognize atherectomies can be appropriate for severe disease, experts told us that most patients with milder symptoms like leg pain while walking, a condition known as claudication, should start with treatments like medication and exercise. propublica.org/article/what-t…

When we examined the data, we found that **thousands** of patients may be undergoing procedures in the earliest stages of vascular disease, possibly too soon or unnecessarily propublica.org/article/thousa…

Doctors named in the data objected to being portrayed as part of the problem. Several rebuffed our analysis, which relied on Medicare claims data and does not have complete clinical info on patient symptoms or disease severity.

You can read more about about the limitations of the data and our analysis in our methodology: propublica.org/article/how-pr…

Even with data limitations, experts said that these kinds of outlier analyses are crucial to protecting patients.

"Most of the public is flying blind," said Johns Hopkins surgeon and researcher Dr. Marty Makary. propublica.org/article/thousa…

We're continuing to report on this and want to hear from patients, doctors, experts and whistleblowers. DM or email at [e-mail], or fill our our form: propublica.org/getinvolved/pe…

And another special shout out to our stellar data partners @CareSet @FredTrotter and Alma Trotter. Learn more about their work here: careset.com