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It's time for the trauma docs to speak up

August 26, 2002|by BOB MAGINNIS

This week some of Maryland's top elected officials and health-care experts met in Annapolis to figure out how to give the doctors who staff the state's regional trauma centers more money and better working conditions. Unfortunately, the Hagerstown contingent of the physicians they're trying to help didn't send a representative.

It wasn't because they weren't invited. House Speaker Cas Taylor said he'd been notified that the doctors had sent word that the meeting hadn't been scheduled far enough in advance for them to attend.

That was unfortunate. Even though Taylor and others put together a plan of action, there's a better chance it will work if Hagerstown's trauma surgeons provide some input, since they're the ones who forced another look at doctors' problems in the statewide system.

All who did attend agreed that the doctors have been caught in a money squeeze that involves falling rates of reimbursement from insurance companies, the many folks who don't have any coverage and a federal rule that prevents Maryland physicians from being compensated for care of the uninsured.

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But though doctors at other regional trauma units are experiencing the same woes, it was Hagerstown where the wheels came off the wagon. State officials asked James Hamill, CEO of the Washington County Hospital, what happened.

Hamill said that when the hospital went to the Level II designation, which requires surgeons in the facility 24 hours a day, the hospital required the orthopedic and neurosurgery practicioners to take trauma call if they wanted hospital privileges.

But Hamill said there are only about 750 trauma cases per year - about two a day . That means it isn't cost-effective for the practicioners, all of whom have private practices, to spend so many hours on call, during which they can't do the elective surgeries that pay the bills.

"Over the past year or so, we had numerous discussions with the specialists and then we came to May and they said they couldn't cover us in June," Hamill said.

Hamill said that "we're working through a lot of frustration and anger, trying to get people to the table and decide what the issues are."

Nevertheless, Hamill said, they've offered the doctors new contracts based on the probability that Hagerstown will become a Level III trauma center. That would allow surgeons to be on call without being on site, as long as they can reach the hospital in 30 minutes.

In an interview a day earlier with Deborah Addo, vice president for patient care services with the Washington County Hospital, she said the trauma surgeons' problems weren't on the "to do" list that CEO Hamill was given when he arrived in September 2000.

Nevertheless, Addo said, hospital officials did sit down and agreed to recruit additional general surgeons. But the neurosurgeons also sought some help, Addo said, because there are only three of them here. In addition to their private practices, she said, they also do some work at other hospitals in the region.

Addo didn't want to talk about specifics of the final meltdown, because, "at this time, people disagree about who said what to whom."

She did say, however, that "whether it's a discussion or difference of opinion, when ultimatums are given, that makes it difficult, or when short time lines are given."

Nor did it help, she said, when the lawyers got involved.

Hamill was conciliatory during the Annapolis meeting, saying that "there is no profession that has been more traumatized, or that has faced more problems, than our physicians."

Hamill also agreed that until some solution to bring in extra funds is found - like putting surcharges on traffic violations or auto insurance policies - the hospital will fund the short-term costs of compensating the trauma doctors.

Taylor's plan to fix the rest of what ails the system goes as follows:

- Assume that Hagerstown will re-open as Level III trauma center, perhaps with a Medevac helicopter based there.

- Meet with the House Bill One task force, to figure out how to get the additional $20 million the system will need into the budget, and

- Have the Maryland Health Services Cost Review Commission determine what is a reasonable rate for reimbursing trauma surgeons for their on-call time.

This could be difficult, according to Del. Michael Busch, D-Anne Arundel, who said that because costs vary in different areas of the state, that rate would have to be adjusted every year.

It's a cinch, however, that what factors HSCRC looks at will be determined before the first adjustment is made. That's why the doctors should speak up now, before they find themselves facing some new regulatory system that doesn't fit because they didn't provide input.

As I sat in the Annapolis meeting, waiting with the group in the hope that one of the doctors would show up, I asked myself this question:

So far the few public comments from the doctors have been angry replies, as opposed to calm explanations. Did they skip the meeting because they feared it would turn into an ugly shouting match?

I can make that speculation because I've talked to some of them off the record about their frustrations. If I'm correct, then I would tell them what they've undoubtedly told many of their own patients: Nothing is accomplished without risk. And when contemplating a fix, timing is everything.

Just months away from an election, Taylor and the other elected officials will never be more motivated to fix this problem. But while the state officials working on this are good people, they are not mind readers. The doctors should talk to them.

Bob Maginnis is editorial page editor of The Herald-Mail newspapers.

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