Call responsibilities

Thu Dec 6 20:02:58 GMT 2007

Dr Sise,
 You are sooo rite. Our leadership should start thinking out of the box
or very few people will be willing to take trauma call, acute care
initiative will not fly without appropriate reimbursement. ACS should
narrow the pool of surgeons that can take trauma based on  demonstrable
skills, either do a good job or close the shop. A resident right out
from the residency can not just go out and do a lap bariatric by pass.
But,  he or she can take care of a GSW to the abdomen, in a patient that
can die if appropriate decisions are not made instantly. I am sure in
this day and age residents in most programs to more fat surgeries than
explorations for trauma.
 Reimbursement should be based on effort and responsibility rather than
scarcity of a surgical specialist.
Naveed 

-----Original Message-----
From: Sise, Mike MD [mailto:Sise.Mike at scrippshealth.org] 
Sent: Thursday, December 06, 2007 7:36 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Call responsibilities

We really do need to be effective in getting financial support for our
services. After 20 years of trauma call and close to 15 of those years
as the managing partner of my group and the trauma medical director at a
private Level I center, I've concluded that whether you are at a
University, a public hospital, or a private hospital, where there is
money paid there is respect for your services on the part of
administration. If they don't pay you properly, they aren't giving you
the respect you are due. Every time I go into the front office to
request more support, I try to be prepared with two numbers, the
relative market value of our trauma call services and the return on
investment for the medical center that the increased level of support
will bring. For instance, I recently secured a small monthly stipend for
two trauma surgeon colleagues to share a more active role as the leads
for our critical care efforts. I was able to tell our CEO that 4 hours
of our time a week compensated at the usual Medicare/CMS administrative
rate ($125) would save many multiples of that every week in reduced
complications, ventilator days, etc. He knew I had the numbers to
support it and he agreed. But to do this kind of advocacy for the
service, you've got to have the numbers. How much is your service making
or losing for your medical center? If they are making money then they
need to pay you appropriately for your contributions to the bottom line.
If they are losing money, then show them a package of cost savings and
get rewarded for it. They are business people, they pay industry
partners for this type of deal all the time! Find out how much other
centers (private centers too if you are a University or public hospital)
are paying their trauma surgeons, specialty call panels, and medical
directors.  If you're the trauma medical director working 50 to 60 hours
a week putting out fires, teaching, meeting with disruptive staff, etc.,
and they are not paying you the full time equivalent administrative
salary allowed by Medicare/CMS of $240,000, you are being taken for
granted and need to get on their case to pay you fairly. And one final
recommendation, don't get angry. Never attribute to malice that which is
due to ignorance or lack of focus. Get even - fair pay for services and
a sustainable growth in compensation based on performance. It takes one
hell of a lot of work to achieve this kind of relationship with the
medical center's administration. I don't see that we have any
alternative.

Mike Sise
San Diego

________________________________

From: Jeffrey Hammond [mailto:hammond at umdnj.edu]
Sent: Wed 12/5/2007 6:55 AM
To: Trauma &amp; Critical Care mailing list
Cc: trauma-list at trauma.org
Subject: Re: Call responsibilities

Wow! This reply was a real pick-me-up. We (Trauma/CC) often feel taken
for granted and "K" has certainly put our skill sets into perspective. I
feel better about myself already!

Jeff Hammond 

----- Original Message -----
From: KMATTOX at aol.com
Date: Tuesday, December 4, 2007 8:51 pm
Subject: Re: Call responsibilities
To: trauma-list at trauma.org

>  
> 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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