This feature of STS News welcomes views and comments from all of our members. It does not necessarily represent the thinking or policy of the Society. STS reserves the right to edit copy for space.
I was perusing the May 2000 issue of STS News, relating our groups efforts to convince HCFA that a valve replacement is perhaps equal to, or slightly more valuable than, say, transmission service on a pickup truck, when a colleague walked by. His face was a collage of surprise, anger, and wounded pride. A closed graft; disappointed patient, anxious family, embarrassed surgeon, mildly censorious cardiologist.
In his article, Dr. Replogle speaks of presenting to HCFA documented facts and hard data (both, of course, known allergies to this tentacle of government). This elixir is then placed into a blender with other data and formulas and the resultant cocktail is our reimbursement, the kind you can drink all night and still walk a straight line. Without the efforts of our Society and its PAC, this continuous devaluation of our services would result in our seniors (often the most affluent segment of the population) contracting our services via a coupon found at the bottom of a box of All-Bran.
Of course I understand budgets and demographics and priorities and the need to somehow standardize the reimbursement riddle. I also understand our innate vulnerability. One of my U.S. Senators told me bluntly, There are 2,500 of you in the whole country, maybe a dozen in our state, and, frankly, everyone thinks youre rich. When HCFA wields its chainsaw, expect few mourners.
My resentment in this process isnt toward the idea that it costs us nothing to run our practices. That concept is silly enough that, although Ill fight it with Dr. Replogle, I cant take it seriously. My problem is that a governmental entity will quantify my relative value and then proceed to incrementally cheapen it.
What about my above-mentioned colleague, shuffling around this week wondering if hes still got game? How many RVUs for that buffet of treats? Ah, yes, how about a little ST segment elevation, that molten bolt of electricity that rends your diaphragm after youve come off pump and the PA pressures are rising? How many RVUs do I hear for the phone calls, that number on your beeper that you just know is trouble: Well, he just put out another 275, and that was just in about 40 minutes, and Ive gone up on the levo... Do you get credit for those hours on vacation after youve left town, when your daughter wonders why youre so grumpy, when all you can think about is whether the gastric tube in that transhiatal is going to just die?
How many RVUs for THAT walk down the hall to the waiting room? How many units for those memories and cases and faces that are simply too painful and threatening to articulate?
Yes, I do want to be compensated well, because I have traded a chunk of my soul and peace of mind and gastric mucosa and nearly all of my hair so I can step up and take people to the edge of the veil. Not everyone can do what you and I can - in fact, precious few can. Why wait until you are 35 to start a real job, staying at the top of your class the whole time, spending your youth under fluorescent lights working 90 hours a week?
It amuses me that the Justice Department so vigorously prosecutes Microsoft for antitrust violations while, at the same time, Medicare fixes prices for all our senior patients. So we negotiate with a single payer, piling before its agents justification for what we do: Please, sir, we work hard, and we have bills to pay. In his presidential address this last January, Dr. Kouchoukos spoke of paradoxes. The great paradox in our dealings with HCFA is that we negotiate a price for a product, the price of which declines while the quality continually increases. I have not seen the RVUs increase for doing older and sicker patients.
When my avaricious eating habits and family history collide, I want a slick, confident, and, yes, well paid surgeon taking the snap. I will not begrudge him or her any number of homes, ranches, yachts, airplanes, ex-spouses, failed limited partnerships, or any other pacifiers required to keep him or her from running screaming from the OR during my operation. I want a paranoid nervous wreck who does perfect grafts, so the numbers will be good, so the business will keep coming, so the money will flow, so the conversion from single to twin engine will happen. I believe in a market economy, and my life is worth a lot to me. I dont care how well motivated a person is or how many Mother Theresa fellowships theyve done - we are not going to have the top talent in this field that we have now if the money isnt there. If HCFA were running the NBA, Shaquille would be playing football.
It seems odd to me that in this irrationally exuberant economy,
the most risk-taking, intelligent, and skilled persons are making
less money. Let us not apologize for who we are, what we do, and
what it costs us.
Alan Muskett, MD
2900 12th Avenue N.
Billings, MT 59101
TKRFXRS@aol.com
