Docgeorge said:
Could you please cut and paste the articles.
Posted on Sat, Mar. 27, 2004
San Antonio Hospitals Face Labor Shortage as Surgeons Avoid Uninsured E.R. Work
By Travis E. Poling and Nicole Foy, San Antonio Express-News Knight Ridder/Tribune Business News
Mar. 27 - San Antonio surgeons are shying away from on-call duty for emergency surgery at downtown hospitals.
The problem: They aren't being paid for all the emergency surgery they do.
On-call surgeons are obligated to operate on any patient in an emergency room. At downtown hospitals, that means they're treating a higher proportion of uninsured patients with little means to pay hospital bills or surgeons' fees.
There's also a greater likelihood that emergency surgery patients at downtown hospitals are insured under Medicaid, the state- and federal-funded insurance program for the poor and disabled. Medicaid reimbursements aren't as generous as private insurance, which also has slashed payments during the last two decades.
That's forced some hospitals to pay top dollar to some surgeons to be on standby. Others find it more cost effective to transfer the patients to other hospitals rather than pay the price.
The problem is a national one that's reached San Antonio in the last few years. Surgeons say they can't absorb the greater financial risk of operating on patients who can't pay their bills after treatment in downtown emergency rooms. Also, surgeons are paying more -- sometimes much more -- for malpractice insurance.
"Physicians are finally to the point that they are tired of being dumped on," Dr. Daniel Gutierrez, chief of surgery for Methodist Metropolitan Hospital, said. "You just can't do (unpaid on-call) anymore as a business decision." Gutierrez said he's had no malpractice claims yet will pay more than $51,000 this year for malpractice insurance, up from $31,000 last year.
For downtown hospitals, the dilemma means that they're often transferring patients needing surgery to North Side hospitals, where more surgeons are available.
At the same time, the hospitals are taking a financial hit. They're paying -- per day per on-call doctor -- from $1,200 for general surgeons to $3,000 for neurosurgeons.
General, orthopedic, trauma, obstetric and neurosurgeons are those most in demand, along with anesthesiologists, who are needed for every surgery.
The situation is complicated by the fact that different hospitals have various policies for on-call work.
Both Baptist Medical Center and Methodist Metropolitan don't pay surgeons to be on emergency call. Baptist has surgeons on staff who cover as many on-call shifts as possible, but in the gaps or for certain specialties, ER doctors have to stabilize patients and send them to other Baptist hospitals on the North Side.
ER doctors at Baptist and most private hospitals are independent groups paid under a contract with the hospital. The surgeon who takes over the patient, however, is independent of the ER doctors and the hospital and runs the risk of not getting paid.
Dr. Carol Wratten, president of Baptist's Executive Medical Board, said a task force to deal with the issue is committed to more equitable coverage at all Baptist hospitals without asking for extra pay.
Christus Santa Rosa Hospital downtown and Southwest Texas Methodist in the South Texas Medical Center both pay about $1,200 a day for each surgeon to be on call. Neurosurgeons get more.
"The straw that broke the camel's back was when they paid surgeons at some hospitals and not at others," Gutierrez said. He also practices at Baptist Medical Center downtown and both Christus Santa Rosa campuses.
At Baptist Medical Center, chief of surgery Dr. Sabas Abuabara said sometimes 20 percent of the patients he treats during a week of being on call can't pay for his services. Other surgeons, many of whom want to be dropped from downtown on-call rotation, say about half of their patients can't pay for surgery.
It's especially difficult to keep some specialists, particularly neurosurgeons, on call because their numbers are few.
Some neurosurgeons get about $3,000 a day just to be on call. That may sound like a lot of money to the average person, but the neurosurgeons say they'll suffer a loss if the patient requires a $10,000 procedure.
Methodist Healthcare System pays a premium for on-call neurosurgeons at Southwest Texas Methodist Hospital because of the number of patients suffering life-threatening ailments sent there.
Gutierrez, a neurosurgeon, said none of the four hospitals where he practices have a formal on-call list for neurosurgery because the doctors don't want the legal obligations of being on rotation. (A doctor on the list must respond if called.) Doctors still take unfunded emergency cases, he said, but don't want a defined arrangement.
Severe cases go to University Hospital, but the publicly supported teaching hospital is just emerging from its own neurosurgeon crisis after it lost neurosurgeons last year and fell out of academic compliance. Now, the health system contracts with local military neurosurgeons to provide care.
There's no easy answer to the on-call dilemma that doesn't require more money, hospital officials and doctors say.
"We're working under an unfunded mandate" to provide emergency care to all comers, Baptist spokeswoman Karen May said. Because hospitals also aren't getting paid for uninsured patients, the hospital takes on an additional financial burden when it pays for surgeons to be available.
"It's a philosophical issue all around the nation," May said.
A higher number of patients and more severe cases treated at the Medical Center means Methodist in that location can pay on-call surgeons -- but not at its other location.
Cary Fox, administrator of Christus Santa Rosa Hospital, said his facility considers it a community obligation to have trauma surgeons available at all times. The surgeons, who run their own practices, receive a stipend as an incentive for being on call while still running busy practices.
"For many, it's like, 'Why take the risk if they're doing a favor taking an unassigned patient who is usually unfunded?'" he said. "The financial burden that is already placed on them is great."
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http://www.mysanantonio.com
? 2004, San Antonio Express-News. Distributed by Knight Ridder/Tribune Business News.
