Medicare would save at least $200 million a year and patient survival rates would be far better if most Medicare heart bypass surgery was performed in hospitals that do at least 200 bypasses a year, using medical teams that specialize in such surgery, according to the Health and Human Services inspector general.

Richard P. Kusserow said Medicare patients receive 63,000 bypasses at a total hospital and doctor cost of $1.5 billion a year. The average is $24,588 per bypass for procedures requiring six to 12 days of hospitalization.

But Kusserow said studies by his agency clearly show that "hospitals and surgical teams that specialize in {bypass} surgery and perform more than 200 surgeries per year have better outcomes in terms of mortality rates, lengths of stay and charges," largely because of greater efficiency and experience from having an established regular team of physicians and medical aides who perform the same operation repeatedly.

At the Texas Heart Institute, one of the nation's leading high-volume centers for this type of surgery, Kusserow said the surgery (including hospital costs for up to 12 days) could be performed by the surgical team there for a package price of $13,800 for Medicare and non-Medicare patients, a substantial saving from the nationwide Medicare average. Costs at health maintenance organizations surveyed ranged from $8,640 to $16,300, he said.

Kusserow said it would be cheaper to fly patients to a relative handful of high-volume "centers of excellence" such as Texas and put them and their spouses up at a first-class hotel, with a free car rental thrown in, than to continue to do bypass surgery at small local centers that do a handful of bypasses and do not have a regular, permanent team for them.

On another issue, he said a provision proposed in a recent health bill would in most cases allow doctors who are a "clear and present danger to the patients" to "butcher" patients while an administrative law judge decides whether they can be removed from Medicare cases for poor medical practices.

Under existing rules, a doctor found to be following bad practices by a peer review organization -- a group set up to review Medicare cases -- can be excluded from Medicare, with in-depth administrative and other reviews not held until afterwards.