Chicago - It’s not the place to be in October. Rainy, chilly, and grey, the windy city is not La Jolla or Maui. But the American College of Surgeons traditionally holds its annual clinical congress here every three years, so here I am with colleagues, learning the latest developments of our profession.
Unlike at previous meetings, the general mood is somber. Health care reform is in every surgeon’s mind. One survey indicates that up to a third of surgeons are set to lay down their scalpels and seek other avenues of work or retire prematurely if socialized medicine were implemented in the United States. The jubilant greetings I encountered, the happy faces I saw were those of physician surgeons visiting from outside the states -- Italians, Chinese, Filipinos, Argentineans, Japanese, Vietnamese, Africans were excited to be in Chicago. They could hardly wait to test the latest DaVinci robotic instrument and try out other American-made surgical innovations.
Every morning, I take the taxi from Union Square to McCormick West, where the congress is held. I take the taxi again every evening back to the train station. Having left New York for Southern California twenty-four years ago, I am reminded that the thirty degree weather now cuts through my woolen clothing and bites my bones. From the relative warmth of the crowded Metra Station, I rush to the comfort of the back seat of a taxicab. At times, I just peer out at the crisp skyscrapers and wonder how people can live in the bitter cold. Most of the times, I chat with the drivers.
I met two drivers from Poland, one from Czechoslovakia, an immigrant from Algeria, a transplant from South Korea, a Caribbean, a native Irish woman from Chicago. Their driving mode, temper, attitudes, political, cultural, and religious views vary, as expected. Others are politely quite, some are chatty. Some are happy and love their job. Others are sour and work in silent desperation. I find them all interesting.
The happiest was Piotr or Peter. He had immigrated with his family from Poland fifteen years ago. His children are in their twenties and early thirties, some of them are now married. “To other Poles?”, I asked. “No, no, no -- to Americans. One American from here (Chicago), the other American from South America (Colombia). Ah, these kids”, he laments, “ they have become Americans!”. “Do you still get together for reunions, family holidays?”, I asked. “Yes, but not like in Poland.” I told him that Filipinos like big family reunions and that even here in the states, we try to get together often, specially during Christmas. “Yes,” he agreed, “In Poland, we also have big Christmas celebration with the family. But now, here in America, it’s not easy to get everyone together. This Christmas, we will be spending the holidays in a friend’s house, outside of Chicago.”
The unhappiest fellow was the Czechoslovakian, specially since I initially thought I heard him say he was from Slovenia or Ceausescu’s Romania. He was one sour dude. He had been waiting “for one hour” in the taxi pool and had gotten no passengers. I offered to give him an extra tip, but he said he was so unhappy, he was going to give me a ride for free! I felt our conversation was not going anywhere, so I asked about his family. I find that subject invariably melts the heart, unless I am in conversation with a hardened soul. He lightened up a bit. Czechoslovakia was better when it was a communist country, he declared outright. I reminded him about the oppressed masses under the Communist regime, food lines, etc. “Nah..” he dismissed my comments. “During communist time, everyone had a slice of bread or no bread -- but everyone was equal. Now, only the rich have bread, the poor have nothing.” For a minute, I thought he was talking about the Philippines!
So why did he leave Czechoslovakia? He had won the immigration lottery. Every year, he told me, a lottery is held and four families win passage to the United States. He was one of the four winners, out of 3,500 applicants. He should consider himself lucky, I said. Yes, but then his son got sick, was diagnosed with desmoid tumor or sarcoma and died at age 14. He knew everything there was to know about the cancer because he went to the public library to research the subject. I asked if his child got treated. Yes, a team at the University Hospital had done everything but could not save his boy. No wonder, he carried so much sadness on his shoulders.
The Korean was all business. He did not talk much, but he drove well and was efficient. He had the latest credit card machine installed in between the car seats. All I had to do, as soon as we reached our destination, was swipe my VISA and the trip was paid. He reminded me to add the tip on the machine. As always, I left a bigger tip -- as we all tend to do with credit cards.
The Muslim driver from Algiers was most fascinating. He was pleasantly surprised I knew about the Seven Pillars of Islam. I told him we, Christians, say our morning and evening prayers and occasionally pray the office of the hours, but not as frequently or as regularly as Muslims do. “It is most important we pray”, he tells me,” otherwise how can we live our lives well?” In his distinctly Arabic accent, he laments that children and young adults preoccupy themselves with material things, like video games and computers, but pay little attention to the spiritual dimension of life. So I asked if he were teaching his children Islamic spiritual values. Of course, he says, but it is a constant struggle to inculcate in our children our cultural and religious heritage. Tell me about it, I said silently.
Last but not least, was the Irish woman taxi driver, born and raised in Chicago. She looked to me like a fiftyish grandmother or a teacher. I didn’t asked why she chose to be a driver, just that I didn’t recall ever hailing a taxi driven by a lady. She gave me a nice Irish smile, to indicate somehow that my comment was universal. Was she happy that a fellow Chicagoan was in the White House? Boy, did that question elicit a flurry of political commentary. As it turned out, she was a big Sarah Palin fan! I like Sarah too, I said. Unfortunately, the odds were stacked against her; Katie Couric and her liberal media cohorts did a nifty job of ambushing Palin before national TV. “What is this country coming to?”, she threw up her hands, while still driving carefully. “President Obama wants us to work, work, work so that thousands of lazy bums can sit, sit, sit. What happened to honest-to-goodness American labor ethic?” When the subject turned to federally-funded abortion, she asked if I was a Christian. Roman Catholic, I replied. She happily gave me a Christian pamphlet and a list of spiritual authors she had written on a small pad with a pencil. I had read some of those authors, I told her. Kathy beamed and gave me an Irish blessing as I got out of her taxi and joined the teeming mass of humanity into Union Station, in downtown Chicago.
I learned the latest updates in surgery at the 95th Annual Clinical Congress and precious human vignettes from the taxi drivers of Chicago.
___________________
Dr. Gamboa is the author of the book "Virtuous Healers: Models of Faith in Medicine."
more . E-mails from the Desert - by Dr. Edgar A. Gamboa
25.SEP.09 The doctor is out
28.AUG.09 Health Care Reform: Getting the Facts Right
08.MAY.09 Yosemite's Half Dome
24.APR.09 Obama, Notre Dame and the Culture of Life
27.MAR.09 A friend goes on vacation
06.MAR.09 The Garden of Eden
06.FEB.09 Double Speak
30.JAN.09 A Cup of Tea, Before Sunrise
16.JAN.09 A different kind of Santa
19.DEC.08 A lonely Christmas...
28.NOV.08 The Perils of Capitalism
21.NOV.08 Sold-out Audience Cheers for Asian Silk Road Concert
31.OCT.08 The Sarah Palin Factor
10.OCT.08 Restore Traditional Marriage - Vote YES on Proposition 8
19.SEP.08 Olympics, Philippine Style
08.AUG.08 Wisdom - where to find it?
25.JUL.08 Moonlit Beach
11.JUL.08 Breast Cancer Treatments
27.JUN.08 Breast Cancer 101
13.JUN.08 PATHWAYS
06.JUN.08 Coming Out Soon! "Virtuous Healers"
30.MAY.08 Filipino Nuncio
23.MAY.08 Pan de Sal Cruise
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Friday, October 23, 2009
Friday, September 25, 2009
The Doctor Is Out
EMAILS FROM THE DESERT by Edgar Gamboa, MD, FACS | SAN DIEGO, 9/25/09 -- In the increasingly complicated discussion about health care reform, every legislator and economist seem to suddenly possess a comprehensive knowledge of what is ailing the health care system in the United States.
Everyone – from the corridors of the White House and halls of Congress to newsrooms and TV stations across the nation – knows how to treat this malady. Why is health care in the US getting financially out of control and draining up to 16% of the GNP? Why are 40 million citizens uninsured? Why is the most affluent nation in the world ranked 29th worldwide in infant mortality?
Many solutions have been proposed: a public health option, insurance portability, mandatory coverage of pre-existing disease, tort reform and caps on malpractice award, affordability of formulary drugs, $1.2 trillion stimulus, emphasis on physical fitness and preventive health programs, etc. Criticisms abound as well: health benefits rationing, facilitation of euthanasia or death panels, unrestricted federal funding of abortion, socialized medicine, governmental dominance of the health care industry, stifling of medical research and innovation, elimination of conscience clause for pro-life physicians, etc.
In this raging debate, one important voice has not been listened to. The art and science of medicine rests, in essence, on the relationship between the patient and the doctor, between the one who is sick and the one who, by knowledge and experience gained through years of clinical training and practice, cures that sickness. Everything else revolves around this unique interaction between two human beings.
Yet, in the attempt to improve health care today, albeit well intentioned, the physician has been brushed aside, if not maligned. The politician is in. The doctor is out.
One surgeon addresses this matter in a September 17th letter to President Obama. I quote Dr. Richard Armstrong's letter in its entirety below:
September 17, 2009
President Barack Obama
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500
Mr. President,
I have followed the health reform debate closely from its beginning. In many ways, I have followed this since the beginning of my career in medicine 33 years ago. In your speech to Congress last week you said that the time for bickering should be over and we should get down to the real work of fixing the problems. I agree with you. I have read HR3200 and the proposed bill from the Senate finance committee. I must tell you, Mr. President, that these proposed pieces of legislation will not fix the problems. Each of these or a compromise of the two will do nothing but add to the cost, the bureaucracy and the waste that you have said repeatedly that you want to reduce. Although you have stated that we should keep what works and fix what doesn’t, the reality is that it is our systems of health care delivery, organization of government programs and the insurance industry that represent the true issues. These aren’t working for Americans and are at the heart of the issue. Massive new government intervention, billions of dollars of new government spending and regulation will not solve these problems. The problems will only be multiplied and it will be more difficult for physicians and patients to navigate an already overly cumbersome system. America has the most advanced health care in the world. Although many of the advances in medicine and medical science have benefited from the financial support of the government, it is not the government bureaucracy that is responsible for how far we have come. The success lies with the individual physicians and scientists whose passion for the truth, for solving complex problems and for persisting until they are solved, has given us what we can be proud of as a nation, excellence. The majority of physicians in this country are driven each day by the desire to provide excellent care to each patient they see. Doctors do not begin their days thinking about the joy they will receive from navigating the morass of insurance and government regulations that have become so entrenched in our daily lives. The joy comes from our work, one patient at a time, one problem at a time. The joy comes from a job well done and America’s patients benefit. We have not, as a group, been engaged in a meaningful conversation with the administration or congress about solving the difficult issues of providing health care for all Americans while maintaining quality and integrity. We are a deep well of experience, wisdom and talent. We are willing to come to the table. Yes, American medicine is fragmented. We are not represented by one uniform society. Less than 15% of us belong to the AMA and yet the media and your administration continue to speak as if the AMA speaks for all of us. It does not. Although its member physicians have made tremendous contributions to medical advances and patient care, the corporate organization of the AMA is a part of the problem, not a part of the solution. This physician’s organization, Sermo, has outlined some basic ideas and ways to begin the discussion in our Open Letter and the Physician’s Appeal. You have the podium, Mr. President. You have the ability to slow this legislative freight train down before it pulls us off a cliff that will damage our ability to provide excellent care to America’s citizens, not improve it. Personally, I have no political agenda. I am deeply concerned about the course you are taking. I implore you to take the time to meet with working physicians of America. I implore you to listen carefully for it is the healthcare professionals that have made medicine in America the best in the world, not the government. We can help you move this forward constructively. Please give us that opportunity.
Sincerely,
Richard A. Armstrong MD FACS
more . . . E-mails from the Desert - Dr. Ed Gamboa
28.AUG.09 Health Care Reform: Getting the Facts Right
08.MAY.09 Yosemite's Half Dome
24.APR.09 Obama, Notre Dame and the Culture of Life
27.MAR.09 A friend goes on vacation
06.MAR.09 The Garden of Eden
06.FEB.09 Double Speak
30.JAN.09 A Cup of Tea, Before Sunrise
16.JAN.09 A different kind of Santa
19.DEC.08 A lonely Christmas...
28.NOV.08 The Perils of Capitalism
21.NOV.08 Sold-out Audience Cheers for Asian Silk Road Concert
31.OCT.08 The Sarah Palin Factor
10.OCT.08 Restore Traditional Marriage - Vote YES on Proposition 8
19.SEP.08 Olympics, Philippine Style
08.AUG.08 Wisdom - where to find it?
25.JUL.08 Moonlit Beach
11.JUL.08 Breast Cancer Treatments
27.JUN.08 Breast Cancer 101
13.JUN.08 PATHWAYS
06.JUN.08 Coming Out Soon! "Virtuous Healers"
30.MAY.08 Filipino Nuncio
23.MAY.08 Pan de Sal Cruise
Everyone – from the corridors of the White House and halls of Congress to newsrooms and TV stations across the nation – knows how to treat this malady. Why is health care in the US getting financially out of control and draining up to 16% of the GNP? Why are 40 million citizens uninsured? Why is the most affluent nation in the world ranked 29th worldwide in infant mortality?
Many solutions have been proposed: a public health option, insurance portability, mandatory coverage of pre-existing disease, tort reform and caps on malpractice award, affordability of formulary drugs, $1.2 trillion stimulus, emphasis on physical fitness and preventive health programs, etc. Criticisms abound as well: health benefits rationing, facilitation of euthanasia or death panels, unrestricted federal funding of abortion, socialized medicine, governmental dominance of the health care industry, stifling of medical research and innovation, elimination of conscience clause for pro-life physicians, etc.
In this raging debate, one important voice has not been listened to. The art and science of medicine rests, in essence, on the relationship between the patient and the doctor, between the one who is sick and the one who, by knowledge and experience gained through years of clinical training and practice, cures that sickness. Everything else revolves around this unique interaction between two human beings.
Yet, in the attempt to improve health care today, albeit well intentioned, the physician has been brushed aside, if not maligned. The politician is in. The doctor is out.
One surgeon addresses this matter in a September 17th letter to President Obama. I quote Dr. Richard Armstrong's letter in its entirety below:
September 17, 2009
President Barack Obama
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500
Mr. President,
I have followed the health reform debate closely from its beginning. In many ways, I have followed this since the beginning of my career in medicine 33 years ago. In your speech to Congress last week you said that the time for bickering should be over and we should get down to the real work of fixing the problems. I agree with you. I have read HR3200 and the proposed bill from the Senate finance committee. I must tell you, Mr. President, that these proposed pieces of legislation will not fix the problems. Each of these or a compromise of the two will do nothing but add to the cost, the bureaucracy and the waste that you have said repeatedly that you want to reduce. Although you have stated that we should keep what works and fix what doesn’t, the reality is that it is our systems of health care delivery, organization of government programs and the insurance industry that represent the true issues. These aren’t working for Americans and are at the heart of the issue. Massive new government intervention, billions of dollars of new government spending and regulation will not solve these problems. The problems will only be multiplied and it will be more difficult for physicians and patients to navigate an already overly cumbersome system. America has the most advanced health care in the world. Although many of the advances in medicine and medical science have benefited from the financial support of the government, it is not the government bureaucracy that is responsible for how far we have come. The success lies with the individual physicians and scientists whose passion for the truth, for solving complex problems and for persisting until they are solved, has given us what we can be proud of as a nation, excellence. The majority of physicians in this country are driven each day by the desire to provide excellent care to each patient they see. Doctors do not begin their days thinking about the joy they will receive from navigating the morass of insurance and government regulations that have become so entrenched in our daily lives. The joy comes from our work, one patient at a time, one problem at a time. The joy comes from a job well done and America’s patients benefit. We have not, as a group, been engaged in a meaningful conversation with the administration or congress about solving the difficult issues of providing health care for all Americans while maintaining quality and integrity. We are a deep well of experience, wisdom and talent. We are willing to come to the table. Yes, American medicine is fragmented. We are not represented by one uniform society. Less than 15% of us belong to the AMA and yet the media and your administration continue to speak as if the AMA speaks for all of us. It does not. Although its member physicians have made tremendous contributions to medical advances and patient care, the corporate organization of the AMA is a part of the problem, not a part of the solution. This physician’s organization, Sermo, has outlined some basic ideas and ways to begin the discussion in our Open Letter and the Physician’s Appeal. You have the podium, Mr. President. You have the ability to slow this legislative freight train down before it pulls us off a cliff that will damage our ability to provide excellent care to America’s citizens, not improve it. Personally, I have no political agenda. I am deeply concerned about the course you are taking. I implore you to take the time to meet with working physicians of America. I implore you to listen carefully for it is the healthcare professionals that have made medicine in America the best in the world, not the government. We can help you move this forward constructively. Please give us that opportunity.
Sincerely,
Richard A. Armstrong MD FACS
more . . . E-mails from the Desert - Dr. Ed Gamboa
28.AUG.09 Health Care Reform: Getting the Facts Right
08.MAY.09 Yosemite's Half Dome
24.APR.09 Obama, Notre Dame and the Culture of Life
27.MAR.09 A friend goes on vacation
06.MAR.09 The Garden of Eden
06.FEB.09 Double Speak
30.JAN.09 A Cup of Tea, Before Sunrise
16.JAN.09 A different kind of Santa
19.DEC.08 A lonely Christmas...
28.NOV.08 The Perils of Capitalism
21.NOV.08 Sold-out Audience Cheers for Asian Silk Road Concert
31.OCT.08 The Sarah Palin Factor
10.OCT.08 Restore Traditional Marriage - Vote YES on Proposition 8
19.SEP.08 Olympics, Philippine Style
08.AUG.08 Wisdom - where to find it?
25.JUL.08 Moonlit Beach
11.JUL.08 Breast Cancer Treatments
27.JUN.08 Breast Cancer 101
13.JUN.08 PATHWAYS
06.JUN.08 Coming Out Soon! "Virtuous Healers"
30.MAY.08 Filipino Nuncio
23.MAY.08 Pan de Sal Cruise
Friday, August 28, 2009
Health Car Reform: Getting the Facts Right
As I write about the current national debate on health care, I get a sense of what Pope Benedict XVI might have felt at Regensburg. Compelled to speak about Islam and violence, the Holy Father was keenly aware he was walking on thin ice. The Vatican’s track record during the Crusades was not a shining example of Christ’s teaching on peace and justice . Yet, despite the historical baggage, Pope Benedict forged ahead to address the errors of Islamic fundamentalism.
In good company, therefore, I will speak about health care reform. A short essay like this simply cannot cover the health care debate in a fair and comprehensive manner. So, I will address the issue in a series of articles.
At a recent Knights of Columbus convention in Phoenix, a well-educated Filipino, upon learning that I was a surgeon, brought out the topic of health care reform. From his perspective, the solution to providing health care to 40 million people without medical insurance was simply to reduce payments to physicians, hospitals, and drug companies. He must have read the USA Today interview of House Speaker Nancy Pelosi, who assured the nation that securing $1.4 trillion to fund a new government program was easy – the government would simply tax doctors, hospitals, and pharmaceutical companies.
So I asked my brother knight what he thought I would get compensated for if I got out of bed at 2 in the morning, rushed to the ER to examine a patien t, reviewed the blood tests and CT scans, diagnosed appendicitis, then brought the patient to the Operating Suite for emergency surgery. And what if I kept the child or adult in the hospital for several days of intravenous antibiotic treatment, saw him or her every day on rounds, conferred with the nurses and updated the family regarding the patient’s clinical progress, then checked the patient again in the office for the next couple of weeks until he or she could go back to school or work?
My fellow knight promptly mentioned a dollar amount that was easily ten times what I would actually get paid for. Assuming, I did not get an IOU check from Sacramento, as is happening these days under the state budgetary crisis.
And what did he think I would get paid for services rendered after surgery? He guessed wrong again. How about zero dollars, I said. Everything that surgeons do after surgery falls into what is called a postoperative “global period” of 60-90 days when all services provided for the patient are free.
He thought I was joking. “Doc,” he said, “don’t you get paid $500 every time you opened a chart?” This led me to conclude that he (and millions of Americans) must have been listening to the President of the United States who claimed that surgeons got $50,000 for amputating a leg. I wonder on which planet these surgical fees are being disbursed. Overworked physicians can certainly use such generous reimbursements here on earth for the ever increasing malpractice premiums we pay to protect ourselves from lawsuits that have become casino lotteries for patients and malpractice lawyers.
Knowledgeable experts estimate that if tort or much-needed malpractice reforms were instituted, and defensive medicine eliminated, health care expenditure in the United States will immediately be reduced by $200 Billion a year.
Last year, an article entitled “Patient Perception of Medicare Fee Schedule of Laparoscopic Procedures was published in a surgical journal (Surgical Innovation, September 19, 2008). It was a study conducted by a team from the University of Miami School Of Medicine and presented to the Society of American Gastrointestinal Endoscopic Surgeons annual meeting.
Concerned that the public (and congressional representatives) are under the erroneous notion that physicians receive substantial remuneration for surgical procedures, the team surveyed 96 patients. 83% of the patients had been operated on.
The survey revealed the following: Almost all of the patients (98%) thought Medicare should pay more for technically difficult surgical procedures. 32% felt Medicare paid physicians well but 91% thought Medicare should increase fees for doctors.
Interestingly, patients thought that surgeons were paid $14,963 for a gastric bypass operation and that Medicare should increase payment for the laparos copic procedure to $16,877, when, in fact, Medicare pays only $1,504 for such an operation.
For gallbladder surgery, patients thought that surgeons were paid $8,746 and that they deserve to be paid $10,555 for the operation. In actual fact, Medicare pays $620.
Medical students surveyed in a 2007study thought that surgeons got paid $3,000 for gallbladder surgery while most surgeons thought they were getting paid $700. Again, the actual payment was $620 for removal of the gallbladder by laparoscopic surgery. Such compensation also included medical care before and after surgery.
For initial patient visit to the doctor’s office, the survey showed that patients think Medicare pays $144 and that doctors deserve to be paid $181. In fact, Medicare pays surgeons $90.58 for a patient’s visit. Additional visits are paid lower.
The study concluded that “lawmaker perception of Medicare physician reimbursement probably resembles public perception, which may explain the fact of the ever-threatening cuts in Medicare reimbursement to physicians.”
Next year, Medicare plans to cut reimbursements further by another 20%.
Jolted by facts, my friend in Phoenix said that Medicare had trouble containing costs and that Medicare constitutes only a fraction of most medical practices anyway. He was right. Depending on type and location of practice, Medicare makes up 20-40%. However, what he did not know is this: most, if not all insurance companies, now set fee schedules as close to Medicare rates as possible. And Medi-Cal rates are even lower than Medicare.
That is why most physicians, while recognizing the value of universal heal th care, are concerned that the proposed government option plan will be nothing more than a Medicare clone.
I will examine another aspect of health care reform in the next article.
more . . . E-mails from the Desert - Dr. Ed Gamboa
28.AUG.09 Health Care Reform: Getting the Facts Right
08.MAY.09 Yosemite's Half Dome
24.APR.09 Obama, Notre Dame and the Culture of Life
27.MAR.09 A friend goes on vacation
06.MAR.09 The Garden of Eden
06.FEB.09 Double Speak
30.JAN.09 A Cup of Tea, Before Sunrise
16.JAN.09 A different kind of Santa
19.DEC.08 A lonely Christmas...
28.NOV.08 The Perils of Capitalism
21.NOV.08 Sold-out Audience Cheers for Asian Silk Road Concert
31.OCT.08 The Sarah Palin Factor
10.OCT.08 Restore Traditional Marriage - Vote YES on Proposition 8
19.SEP.08 Olympics, Philippine Style
08.AUG.08 Wisdom - where to find it?
25.JUL.08 Moonlit Beach
11.JUL.08 Breast Cancer Treatments
27.JUN.08 Breast Cancer 101
13.JUN.08 PATHWAYS
06.JUN.08 Coming Out Soon! "Virtuous Healers"
30.MAY.08 Filipino Nuncio
23.MAY.08 Pan de Sal Cruise
search archives
Keywords:
Issue date:
· Type either Keywords, Date or both.
· Date examples: 5/30/02, >5/30/02
In good company, therefore, I will speak about health care reform. A short essay like this simply cannot cover the health care debate in a fair and comprehensive manner. So, I will address the issue in a series of articles.
At a recent Knights of Columbus convention in Phoenix, a well-educated Filipino, upon learning that I was a surgeon, brought out the topic of health care reform. From his perspective, the solution to providing health care to 40 million people without medical insurance was simply to reduce payments to physicians, hospitals, and drug companies. He must have read the USA Today interview of House Speaker Nancy Pelosi, who assured the nation that securing $1.4 trillion to fund a new government program was easy – the government would simply tax doctors, hospitals, and pharmaceutical companies.
So I asked my brother knight what he thought I would get compensated for if I got out of bed at 2 in the morning, rushed to the ER to examine a patien t, reviewed the blood tests and CT scans, diagnosed appendicitis, then brought the patient to the Operating Suite for emergency surgery. And what if I kept the child or adult in the hospital for several days of intravenous antibiotic treatment, saw him or her every day on rounds, conferred with the nurses and updated the family regarding the patient’s clinical progress, then checked the patient again in the office for the next couple of weeks until he or she could go back to school or work?
My fellow knight promptly mentioned a dollar amount that was easily ten times what I would actually get paid for. Assuming, I did not get an IOU check from Sacramento, as is happening these days under the state budgetary crisis.
And what did he think I would get paid for services rendered after surgery? He guessed wrong again. How about zero dollars, I said. Everything that surgeons do after surgery falls into what is called a postoperative “global period” of 60-90 days when all services provided for the patient are free.
He thought I was joking. “Doc,” he said, “don’t you get paid $500 every time you opened a chart?” This led me to conclude that he (and millions of Americans) must have been listening to the President of the United States who claimed that surgeons got $50,000 for amputating a leg. I wonder on which planet these surgical fees are being disbursed. Overworked physicians can certainly use such generous reimbursements here on earth for the ever increasing malpractice premiums we pay to protect ourselves from lawsuits that have become casino lotteries for patients and malpractice lawyers.
Knowledgeable experts estimate that if tort or much-needed malpractice reforms were instituted, and defensive medicine eliminated, health care expenditure in the United States will immediately be reduced by $200 Billion a year.
Last year, an article entitled “Patient Perception of Medicare Fee Schedule of Laparoscopic Procedures was published in a surgical journal (Surgical Innovation, September 19, 2008). It was a study conducted by a team from the University of Miami School Of Medicine and presented to the Society of American Gastrointestinal Endoscopic Surgeons annual meeting.
Concerned that the public (and congressional representatives) are under the erroneous notion that physicians receive substantial remuneration for surgical procedures, the team surveyed 96 patients. 83% of the patients had been operated on.
The survey revealed the following: Almost all of the patients (98%) thought Medicare should pay more for technically difficult surgical procedures. 32% felt Medicare paid physicians well but 91% thought Medicare should increase fees for doctors.
Interestingly, patients thought that surgeons were paid $14,963 for a gastric bypass operation and that Medicare should increase payment for the laparos copic procedure to $16,877, when, in fact, Medicare pays only $1,504 for such an operation.
For gallbladder surgery, patients thought that surgeons were paid $8,746 and that they deserve to be paid $10,555 for the operation. In actual fact, Medicare pays $620.
Medical students surveyed in a 2007study thought that surgeons got paid $3,000 for gallbladder surgery while most surgeons thought they were getting paid $700. Again, the actual payment was $620 for removal of the gallbladder by laparoscopic surgery. Such compensation also included medical care before and after surgery.
For initial patient visit to the doctor’s office, the survey showed that patients think Medicare pays $144 and that doctors deserve to be paid $181. In fact, Medicare pays surgeons $90.58 for a patient’s visit. Additional visits are paid lower.
The study concluded that “lawmaker perception of Medicare physician reimbursement probably resembles public perception, which may explain the fact of the ever-threatening cuts in Medicare reimbursement to physicians.”
Next year, Medicare plans to cut reimbursements further by another 20%.
Jolted by facts, my friend in Phoenix said that Medicare had trouble containing costs and that Medicare constitutes only a fraction of most medical practices anyway. He was right. Depending on type and location of practice, Medicare makes up 20-40%. However, what he did not know is this: most, if not all insurance companies, now set fee schedules as close to Medicare rates as possible. And Medi-Cal rates are even lower than Medicare.
That is why most physicians, while recognizing the value of universal heal th care, are concerned that the proposed government option plan will be nothing more than a Medicare clone.
I will examine another aspect of health care reform in the next article.
more . . . E-mails from the Desert - Dr. Ed Gamboa
28.AUG.09 Health Care Reform: Getting the Facts Right
08.MAY.09 Yosemite's Half Dome
24.APR.09 Obama, Notre Dame and the Culture of Life
27.MAR.09 A friend goes on vacation
06.MAR.09 The Garden of Eden
06.FEB.09 Double Speak
30.JAN.09 A Cup of Tea, Before Sunrise
16.JAN.09 A different kind of Santa
19.DEC.08 A lonely Christmas...
28.NOV.08 The Perils of Capitalism
21.NOV.08 Sold-out Audience Cheers for Asian Silk Road Concert
31.OCT.08 The Sarah Palin Factor
10.OCT.08 Restore Traditional Marriage - Vote YES on Proposition 8
19.SEP.08 Olympics, Philippine Style
08.AUG.08 Wisdom - where to find it?
25.JUL.08 Moonlit Beach
11.JUL.08 Breast Cancer Treatments
27.JUN.08 Breast Cancer 101
13.JUN.08 PATHWAYS
06.JUN.08 Coming Out Soon! "Virtuous Healers"
30.MAY.08 Filipino Nuncio
23.MAY.08 Pan de Sal Cruise
search archives
Keywords:
Issue date:
· Type either Keywords, Date or both.
· Date examples: 5/30/02, >5/30/02
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