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Wed Dec 5 01:08:13 GMT 2007

In a message dated 12/4/2007 6:09:05 P.M. Central Standard Time,  
rgross at harthosp.org writes:

Ken,

When can I start as an attending on your service - it might  take me a day or 
so to move, but I am available after that!    ;-)

Ron

Ron:  Thank you for volunteering to be a faculty with us.    We are not at 
the level of understanding or support that I cited in my  letter.   I wanted to 
share with this list server what is happening  across the country, often 
quietly.     I am aware of at  least one hospital that is paying surgeons and 
neurosurgeons $5000 per 12 hour  shift to take call from home.     FROM  HOME.    

The numbers and principles I cited are probably LOW compared to the VALUE  to 
the rest of the hospital and especially to the rest of the surgical  
services.   It is important that every acute care, emergency, trauma,  general surgeon 
understand their worth, leverage, and benefit to patients and  the rest of 
the health care enterprise.     DO NOT UNDERSELL  yourself or allow yourselves 
to be USED.      

You have many values and benefits to patients, other doctors, hospitals,  and 
to society.   

1.    Your TIME is very valuable.   Your  "call pay" is to pay you for YOUR 
TIME, just as lawyers, and many other  professionals are paid for their time.   
You get paid just for being  there.  PERIOD.   You should never do this 
physical presence just  for free.     The value for this time for the many things  
you do for the community, hospital enterprise can be estimated and supported 
to  be from $100.00 to (in some instances) more than $300.00 per  hour.    Your 
hospital administrator knows that very well from  his allocation analyses.   
The CFO of your HMO knows your value very  very well, they just do not want 
you to know as most acute care, trauma,  emergency, general surgeons have 
allowed themselves to be painted into a corner  and forced to accept a far too low 
stipend.    

2.    Your SERVICES and EXPERTESE are becoming very  rare.   The number of 
acute care, emergency, trauma, general   surgeons who are very comfortable and 
effective in an open neck, chest, abdomen,  or groin is decreasing daily.     
This person is the bedrock  of the medical establishment of EVERY community.   
For a community to  not have such a person, is a very unfortunate community.   
   Your payment for these services can calculated many ways, AND MUST NOT 
EVER BE  DISCOUNTED or compared to simpler laparoscopic or endoscopic or 
uncomplicated  technical repetitive tasks.     The fee schedule for these  services is 
more like the fee for services amounts of the 1980s than the double  
discounted Medicare level, $0.30 on the Dollar voodoo health payments of HMOs,  
government plans, and salary arrangements.    

3.    Your understanding of SYSTEMS approaches and  DISASTER availability to 
your community is unparalleled.   You are the  foundation of survival.   This 
fact is well known by your local EOC  and stage agencies.   NO ONE ELSE but 
you are literally available 24/7  for the entire community, and can do 
everything needed for such responses and as  history has shown, have been there when 
society and civilization needed  you.  

I am so proud to know so many of you who are among the best clinicians in  
the world.    I would be happy to hire many of you, but in a  different battle, 
the money available to physicians may be sparse for the next  few months.   I 
have drawn a line in the sand regarding the  proposed Congressional Medicare 
cuts of 10.1% to physicians and have many other  physicians nationally that 
have made the same personal decision and communicated  such to Congress.     I am 
sick and tired of the perennial  charade of doing at the edge adjustments of 
partial fixes of the proposed  Medicare cuts by congress only to discover that 
the payments to doctors  continues to decrease, while every other payment 
from Medicare  increases.   Obscene.    

SO,   I have stated that I am opposed to ANY congressional "fix"  to the 
proposed 10.1% Medicare payment to doctors.   Just leave it  where it is and let 
the chips fall where they may, and let everyone let CMS know  just how broken 
the system really is.      If these  issues were in my hospital, it would 
immediately be declared a sentinel event  and a search for a root cause would be 
screamed.    

Kenneth Mattox, MD
Houston

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