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Ann Thorac Surg 1997;64:595
© 1997 The Society of Thoracic Surgeons
President, The Society of Thoracic Surgeons
A Chinese curse states "May you live in interesting times." The first 6 months of the Presidency have indeed been interesting. Changes occurred so frequently and rapidly that I felt a President's Page commenting on them would be out of date by the time it was published. Therefore, we used The Society of Thoracic Surgeons Web site and fax transmissions as a means of communication to the membership. Because we have come to a pause in this frenetic activity, I would like to bring you up to date on the events of the last 6 months.
Six months ago our specialty was faced with a proposed reduction in practice expense reimbursement of 40% to 50%, scheduled to begin on January 1, 1998. This reduction was to be superimposed upon the institution of a single conversion factor resulting in an additional reduction of approximately 10%. These reductions threatened patient access to care due to potential practice closures or inability to afford to operate on Medicare patients.
The Society's leadership responded to this crisis rapidly and with vigor. A Political Action Committee (STSPAC) was established. An assessment was levied upon the active membership. Consultants in Congressional and public relations were engaged. Programs for carrying our message to the Hill were initiated. Twice, visits to the Hill by numerous members of The Society were undertaken. Letter writing and other informational campaigns were instituted. When focus groups of ordinary citizens were apprised of the magnitude of the proposed reductions, they spontaneously determined that the reductions were unfair to surgeons, threatened access to care for Medicare recipients, and would make Medicare a second class health care system.
Not only did our effort require time of the members who volunteered to work in the vineyard, but it also represented a substantial financial commitment. In addition, The Society participated as a prominent member of the Practice Expense Coalition, an organization of medical groups with a common goal. The activities of The Society and the Practice Expense Coalition were parallel. The American Medical Association (AMA) was of considerable help in assisting us in achieving our goals.
Because Congress and the White House had accepted the change to a single conversion factor , our major efforts were directed toward the proposed general practice expense reimbursement reduction and not the single conversion factor, which was already a fait accompli.
The goals were to (1) obtain a 1-year delay in implementation, (2) follow the delay by a 3-year phase-in, (3) have the Health Care Financing Administration (HCFA) completely reevaluate its practice expense methodology, and (4) require that HCFA or other organizations perform a more creditable practice expense study based on standard accounting principles. All of these goals have been accomplished.
One unexpected late development was the insistence of the Senate to transfer to those whose practices deal with limited procedure codes a portion of their projected gain in practice expense reimbursement during the year 1998, even before restudy was completed. They estimated the transfer to be $390 million. In spite of intensive efforts by The Society, the Practice Expense Coalition, and the AMA this decision could not be altered. However, the combined reimbursement decrease to our specialty is dramatically less than those changes proposed 6 months ago.
The first phase of our program has been completed with acceptance of our objectives by the Congress and the President. The next phase is beginning. This phase will deal with continuing to develop our credibility and relationships with those responsible for public policy development and enactment. This will be an ongoing extensive educational process, which will require additional substantial effort and funding.
How did we let ourselves get placed in this position? We have devoted our lives to taking care of patients, improving the care that they receive, and enhancing the quality of their lives. Our record speaks eloquently to our achievements as a specialty. In the past we have felt that doing good work and helping our patients were sufficient to document and support our position. While we were doing this, and doing it well, others have been promoting their contrary views among the country's leadership much to our detriment. We have learned a very painful lesson. If we are to succeed in our eventual goal of restoring recognition of what our specialty has meant and continues to mean to the health of our country, we will have to continue this education of the public, the Congress, and the media.
Our efforts have been funded by a special assessment of the members. It is disheartening to learn that not all members have paid this assessment yet. It is more disappointing to realize that even less of our membership has contributed to the STSPAC. It is time for us all to contribute to the effort by financially supporting this ongoing activity. All of us owe a debt of gratitude to those members who have worked diligently to accomplish what has been done over the past 6 months. This has not been accomplished easily, nor by any single individual. It has been a collective effort. But we need the participation of all the membership. It has been astonishing for many of us to have received comments such as "It's going to be alright, isn't it?" from those who have not paid their assessment or contributed to the STSPAC. It is difficult to understand these attitudes.
To use a baseball analogy, it is time for us all to step up to the plate and contribute our time and treasure to this effort!
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