Douglas R. Bacon, M.D., Editor

Reunion

ecently the CEO of the health system in which I practice sent an e-mail discussing the need for mentors. He spoke eloquently about those physicians who had influenced him since his days as a medical student and how they both inspired and steered him in his career. Highly successful, our CEO took the time to name some of the names that changed the course of his professional life; and he had the chance to do so while these people were still alive and some of them still caring for patients.

In early May, I had the opportunity to spend some time back “home” in Western New York. One of the residents in my mother’s life care community was one of my mentors, Richard Terry, M.D. Dr. Terry and mom arranged to have Sunday brunch with me and for me to have a chance to meet Dr. Terry’s wife, whom he had married after his first wife’s death. My mother had told me what a wonderful person, a true lady, Mrs. Terry is, and I was looking forward to our reunion.

The day was glorious. The sun and early spring flowers were out. It was a great day to walk outside — no jacket was needed. The dining room overlooked the pond within the complex, and there were several goslings and ducklings following behind their parents. Dr. Terry was as I remember him, a keen intellect and very curious about all around him. Yet Dr. Terry’s most striking attribute, remembered from our first meeting about 25 years ago as a second-year medical student, was his kind, encouraging attitude. With the astuteness to be intimidating, to literally crush an aspiring resident (and most attendings) or medical student, Dr. Terry was just the opposite. He was kind, considerate and encouraging — a true mentor.

Dr. Terry remains an important individual to Buffalo anesthesia as he connects the very beginnings of the residency training program, and consequently the academic department of anesthesiology at the University of Buffalo, to the present. He was the second resident hired, and he trained with the first professor and Chairman, John Henry Evans, M.D. Currently the residents’ teaching day at the SUNY Buffalo residency program is named in his honor.

One night when we were on call together, Dr. Terry reminisced about his experiences as a resident during the Great Depression. Dr. Terry spoke of an unusual patient he called “the well-dressed indigent” and described in those pre-Medicare and Medicaid days how physicians expected that at least 10 percent of their work would be uncompensated. The well-dressed indigent was a man who came to the “charity” clinic in a suit and tie, and because he had lost his job and had no money to pay, sought free health care. Later that evening, Dr. Terry opined that health care was certainly simpler and perhaps better before the federal government became involved on such a large scale. It was an interesting point, and one that I had not contemplated.

All these years later, as a member of the Revenue Systems and Compliance Committee, Dr. Terry’s words echoed back to me. The first time this happened was during the discussion about pay for performance and the 1-percent “bonus” Medicare was giving if the institution could prove compliance with the various performance standards. The most interesting part of the discussion was that to collect the data and submit it cost about 7 percent, or a net loss of 6 percent. These numbers raised real concern over participation and, in point of fact, made me wonder why anyone should partake of a program that costs them more than they can recoup. That makes very poor business sense!

A concern expressed in private conversation with one of the committee members was how a small private group would deal with this situation. Not wanting to be put on a list of noncompliant physicians, they would be forced to spend money they may not have to participate. Yet another reason to go out on a financial limb might be that Medicare will increase the reimbursement bonus, but only for those who have participated in the program the previous year.

Recently the committee listened to a presentation about the change in “Medicare Severity DRGs.” In essence this is yet another attempt by Medicare to reduce payments to physicians and hospitals. The original intent was to increase reimbursement for complicated cases, or those with complications, but the documentation required by physicians and those that help with billing is counterintuitive to medical diagnosis. For example, a patient with mitral valve disease no longer qualifies as a complicated case. What does matter, however, is if the patient has respiratory failure or pulmonary edema. For those of us in anesthesiology who are caring for a patient with critical mitral valvular disease, the goal is to avoid either of those two diagnoses. Is there an incentive, however unintentional, to over-exaggerate the patient’s medical condition?

What also caught my attention was the fact that the final rule will not be released until August with implementation to start on October 1. To ensure compliance will take a massive education effort. Planning cannot begin until the rule has been published and studied. In all likelihood, this will take more than the 60 days possible for implementation. If, after a colossal effort, compliance is ensured, there is no guarantee that this system will be in place beyond the 2008 fiscal year. The entire system could change by fiscal year 2009! If this were to happen, all work done for fiscal year 2008 would be wasted.

Thus it is important for us as physicians and anesthesiologists to stay abreast of the workings of the federal government. We can no longer afford to sit by quietly and hope that the Centers for Medicare & Medicaid Services will do what is right by the patients we both serve. Physician reimbursement is one part of a complex equation. Hospital compensation for services rendered should be important to all of us. Many groups function with a stipend from the hospital. If the facility is no longer profitable, from where will the additional money come?

By example, Dr. Terry was always involved. Nearing retirement when I met him, he still taught actively in the operating room each day and gave input on projects that residents were interested in doing. He had a love for the specialty that was evident in everything he did, and he had a gentle way of reminding those of us far junior to him about the importance of being not only an active learner but also active politically to help the specialty. President of the New York State Society of Anesthesiologists (NYSSA) in 1954, Dr. Terry continues to serve NYSSA and ASA at every opportunity.

This month, as we welcome the newest members of the specialty, the incoming residents, let us use the example of our mentors. Displaying the love we have for our specialty, let us guide our new charges — be they residents, new staff or someone wishing to become more involved in organized medicine — with enthusiasm and grace. Let us heed the words of our Washington Office on matters political and answer their calls to action. Furthermore perhaps it is time to consider a contribution to the ASA Political Action Committee as it gears up for the fall campaign season and the presidential elections in 2008.

I know Dr. Terry takes pride in what I have accomplished; his modesty would deny that it was his example that began my trek along this path. For all our Dr. Terry's, for the legacy they left us — the medical specialty of anesthesiology — let us continue to be active at home, at work, within the hospital community and within organized medicine. Let us make a difference — we can and we must.

— D.R.B.

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