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Ann Thorac Surg 2001;71:12-13
© 2001 The Society of Thoracic Surgeons
a Department of Surgery, University of Nevada School of Medicine, Suite 601, 2040 W Charleston Blvd, Las Vegas, NV 89102, USA
e-mail: alittle{at}med.unr.edu
The Health Care Financing Agency (HCFA) is the administrative agency responsible for payment of Medicare charges. The message that HCFA reimbursements have and are continuing to decline is not surprising. This article utilizes classic economic methodology to dramatically emphasize the startling, nearly draconian, impact of these reductions. Although the economic terminology might be new to some readers, the concepts are straightforward, well presented, and easily understood. This article deserves careful reading and thoughtful consideration. It does not relate either the background, history, or structure of the Medicare program or HCFA itself, which are provided in the special report from Tim Gardner, MD [1], on the Medicare program.
The current article reveals the true impact of the reduction in payments using the consumer price index to add the impact of general inflation to the analysis. If one compares 1988 allowed Medicare charges to 1998 allowed charges, the reductions might appear to a casual observer to be modest and tolerable, at least in some instances. For example, the reduction in allowable charges from 1988 until 1998 for a pneumonectomy is "only" a reduction of 20% from $1,794.00 to $1,453.00. However, when one looks at the actual value of the payment, the percent loss of purchasing power in the market place is 42%. This is the value that has the real impact on an individual. As demonstrated in Table 1, the purchasing power value of payments for a range of selected operative procedures has decreased by amounts ranging from 58% to 42%. When one considers the other side of the picture, not addressed in this article, the scene is even bleaker. At the same time the true value of reimbursements is falling, practice expenses including rent, staff salaries, and medical equipment have increased. As diminishing reimbursement approaches rising practice expenses in the context of the clinical demands of caring for elderly patients, access to cardiothoracic services will be challenged as individual surgeons reluctantly come to the inevitable conclusion that "It’s just not worth it."
What message should be drawn? Despondency and resignation are useless and nonproductive; however, irritation and even anger are unavoidable. We and our patients are being treated with disdain as exemplified by the political decision to redistribute Medicare dollars from specialists to primary care practitioners. Determination of HCFA payment policies is a political process and must be addressed through the appropriate political channels. And it is no longer possible to stay aloof from the fray. Being passive and remaining disconnected from the political process will lead to the worst case scenario in which the cost of caring for older patients approaches the value of remuneration and access to cardiothoracic surgeons becomes problematic. If individual cardiothoracic surgeons do not engage their congressional representatives, there will be no congressional action. There is guidance available through society leadership, the AATS/STS Joint Committee on Professional Affairs headed by Dr Gardner, and Bob Wilbur, the director of Government Affairs for the STS. All of these resources are available and eager to provide support to gain access to the appropriate congressional delegation. Our patients’ futures are in our hands.
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