Published 2/1/2008

Medicare debate entering second stage

My compliments to Bob Fine and his co-authors on their comprehensive article regarding Medicare payment. With this information in hand, the next stage of the debate regarding Medicare and our position must begin. We now know how we are being disadvantaged. We also can infer that Congress, consciously or subconsciously, is precipitating a crisis in Medicare to which it can therefore react. I think our Association can assist them in their endeavor.

These are my thoughts. There is a floor of reimbursement, beneath which we may already have fallen and below which it makes no sense in our current circumstances to continue to provide highly skilled and high liability services. I believe the AAOS should begin a rapid response survey of its membership, either through e-mail or faxes, posing the following questions:

  1. Are you satisfied with your current rate of reimbursement from Medicare?
  2. When would you feel action would be warranted regarding your Medicare participation?
    1. When rates are cut 10 percent more?
    2. When rates are cut 50 percent more?
    3. When you pay more to have your teeth cleaned than get reimbursed for a total hip arthroplasty?
    4. I will continue to participate in Medicare regardless of reimbursements.

The AAOS should then tally the results of the survey and begin discussions at the Board of Directors and at the Board of Councilors regarding what action might be appropriate. History has proven that only large-scale demonstrations of our will are likely to get the attention of Congress when it comes to Medicare funding. Anyone who thinks any alternative might be effective has not been paying attention.

We are the only players in the game who have an incentive to change the current Medicare reimbursement system. No societal change for the better comes without sacrifice, and although our entanglements with Medicare may be complicated (some of us are salaried by universities or, like myself, have contracts that require Medicare participation), these considerations become secondary to our major goal.

I believe action is necessary for the benefit of America, in the way it prioritizes the expenditure of tax dollars; for our patients, who will maintain access to our services; and for ourselves, who will be appropriately reimbursed for our skills. I look forward to the debate and its results. Inaction is unacceptable.

Edward J. Collins Jr., MD
Key Colony Beach, Fla.