Humans are social animals, and, over time, they have found that their best times are spent in groups. We have just celebrated Thanksgiving, spending time with our most important group, our family, reflecting on our present life situation and giving thanks. And more holidays are to come.
As physicians, vascular surgeons belong to many groups besides family: They also are part of practices, hospital medical staffs, operating room teams, ambulatory centers, medical associations and specialty societies.
For most vascular surgeons, the Society for Vascular Surgery (SVS) plays a major group role, with continuing education and networking identified as important activities. Many do not realize that the SVS does so much more. We would like to focus on SVS’ role in representing and influencing the governmental determination of our compensation levels.
Many busy vascular surgeons struggle to remain informed regarding deliberations in Washington, D.C. Currently, the assignment of Medicare dollars to the procedural facet of our multilevel patient care responsibilities is in arbitration. We find it disconcerting that “Medicare budget neutrality” was proposed in 2019 and seamlessly executed without much fanfare. This most current development mandates fiduciary changes set to take place Jan. 1, 2021, and they are not trivial—7% reimbursement cuts.
More specifically, every procedure we perform, from the most basic vascular access to the extraordinarily complex and emergent ruptured abdominal aortic aneurysm repair, would have its associated fee reduced by that much. That’s a very painful pre-tax bite. This inequity is compounded by the zero growth in work relative value unit (wRVU) conversion in addition to absolutely no consideration for inflation over the past several decades. Not only have vascular surgeons failed to receive a raise in more than 20 years, the stated actions will be salary cuts for those of us who provide services to Medicare patients—and private payers often follow Medicare’s lead. In order to neutralize a net negative contribution margin from the low-intensity outpatient fields, the high-risk, high-exposure service lines such as ours are now open season to the budget hawks in Washington, D.C.
The effect of this change in cash flow is most obvious in private practice (revenue-minus-expenses arrangements). But, even fully employed vascular surgeons will ultimately feel this as their contractual RVU conversion factors come under scrutiny at each institution. Failure to appropriately remunerate those taking the biggest risks clinically and investing the lion’s share of their youth to perfect this highly sophisticated craft will erode our ability to care for the patients we love.
Additionally, administration now dominates the healthcare landscape. Over the past three decades middle management has ballooned. Today, physicians are in the rear of most executive-level discussions at most institutions. At the same time, professional fees are used as markers and cash-on-hand assets for the ultimate determination of physician pay. As such, the 7% cut reduces our individual service line profitability. In addition, through a series of not-so-transparent calculations, these cuts will ultimately result in the further dependence of the physician on his/her place of employment and reduction in leverage at all the negotiating tables. Tracking this back to our most sacred mission, it eliminates our ability to advocate for the care our patients need.
Nurturing a new service line or any other dollar-intensive undertaking should be a patient-first equation. Such proposals now are misdirected, with hospital administration fed first. Doctors are at the bottom of the food chain, and as our real earnings are cut by the governmental pig from which we suckle, our ability to implement the latest and greatest are undermined.
The SVS PAC is our voice to our governmental representatives who make these decisions. Through SVS, we have group power. We cannot overstate the importance of a unified voice from our Society, explaining this complex interplay to politicians and demanding equitable reimbursement. So, during this holiday season, we urge all members of the SVS family to remember to give thanks to our Society for all it contributes to our individual and collective welfare. We are measured by our actions. So: please contribute generously to your SVS PAC (vsweb.org/PAC).
Mark A. Smith, MD, and Janice Hong, MD, are members of the SVS PAC Steering Committee.