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Ann Thorac Surg 2001;72:1442-1443
© 2001 The Society of Thoracic Surgeons
a Pebble Beach, CA 93953-2652, USA
e-mail: georgemaryv{at}aol.com
To the Editor
Doctor Weaver’s opinion regarding the devaluation of our specialty’s services both from a societal as well as monetary perspective is well understood by all in our specialty. However, his suggested method of correction has not been successful. Further, we are blocked from being more aggressive by existing Federal regulations which put even one physician talking with another regarding what would constitute a proper fee at risk of being charged with fee fixing. These regulations make it virtually impossible for physicians to form an organization to collectively negotiate fee structure. This is especially frustrating when, for example, in the State of California, five health plans regulate 90% of the patient market. Hardly an even playing field.
With this regulatory background, Congress and The Health Care Financing Agency (HCFA) using Professor Hsiao’s RBRVS method of medical fee determination constructed the framework that has led to this level of devaluation which probably even Dr Hsiao did not envision. Not only have they limited remuneration for service to Medicare patients, but they have empowered private insurers, including managed care organizations to do the same. Of course the private companies do it even better than the Federal Government. Note the fortunes that have been amassed by many of these organizations’ leaders and their stockholders. For example a fee of over one billion dollars reportedly paid to one individual for putting together two health insurance organizations. Six of the ten highest paid executives in a community working for one HMO. Further, in the minds of the Federal Government as well as the entrepreneurs, what we have is simply "work in progress", and the devaluation will become even more draconian.
What has become of the approximate one and one-half trillion dollars per year spent for medical care in this country? Over the past ten years, the physician component of the health care dollar has decreased 25%, Hospital component has minimally risen. Pharmaceutical costs have increased eighteen percent per year in recent years. Presently, it is generally held that 43% goes to the hospital, 29% goes to the physician (down from 40% ten years ago), 18% to pharmaceuticals, and 10% to skilled nursing facilities and rehab.
This concern for the future of our specialty and medical care for our citizens is brought to an even higher level of intensity when we look at the redistribution of funds from actual medical care to various entrepreneurial enterprises providing no or little medical care. For example those running various portable imaging devises, full body scans, intermediary analysts, accountants, consultants, advertising agencies, the media, etc. Imagine the costs of the "consultants" that will provide "testimony" that your hospital’s cardiac care program is one of the best one-hundred in the USA plus the costs of full page news advertisements advising your community of this allegation.
There is no apparent quick solution other than the methods being followed by our leadership. Many, including politicians, Congressional representatives, HCFA representatives, and other so called Health Care experts state that until patients cannot receive care, the devaluation will continue. It is of utmost importance that we continue to support our leadership in this struggle.
Related Article
Ann. Thorac. Surg. 2001 72: 1442.
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