Obama Missteps on Foot Amputation Pay to Surgeons
Cheryl Clark, for HealthLeaders Media , August 14, 2009 At least three large physicians' groups, and many physician bloggers yesterday blasted President Obama for saying that a surgeon makes $30,000 to $50,000 to amputate the foot of a diabetic, while receiving a pittance to prevent the diabetes that necessitated the procedure in the first place.
That is wrong, said members of the American Academy of Orthopaedic Surgeons, the American College of Surgeons, and the California Medical Association. Numerous bloggers and pundits promptly pounced on his statements, some calling him "idiot-in-chief."
"The CMA wholeheartedly agrees with the President on the importance of prevention, but the examples he used were inaccurate and offensive and could undermine the trust central to the physician-patient relationship," said the California group, which represents about one-fourth of the state's 125,000 licensed doctors.
"President Obama got his facts completely wrong," according to a statement from the ACS, whose 74,000 members make it the largest organization of surgeons in the world.
"In fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation," sais ACS, which is care that includes evaluation of the patient the day of the operation and follow-up care that is provided for 90 days after the operation.
Private insurers pay a variation of the same amount, said the group, adding that it is "deeply disturbed" over the President's "uninformed public comments."
In fact, the cost of a foot amputation includes payment to the hospital for several days' stay, to an anesthesiologist and rehabilitation specialists, and for wound care after the surgery is over. But the surgeon doesn't charge those amounts. A 2007 article in the Journal of the American Podiatric Medical Association estimates the cost of a lower extremity amputation at $30,000 to $60,000, with an additional $43,000 to $60,000 for subsequent care for 3 years.
At a Town Hall meeting, in Portsmouth, N.H., on Wednesday, Obama said: "Let's take the example of something like diabetes . . . a disease that's skyrocketing, partly because of obesity, partly because it's not treated as effectively as it could be.
"Right now . . . if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's 30,000, 40, 50,000 dollars immediately the surgeon is reimbursed.
"Well, why not make sure that we're also reimbursing the care that prevents the amputation. Right? That will save us money," said Obama.
Orthopedic physicians said they are "profoundly disappointed" with his comments, which had the effect of "blurring the realities of physician reimbursements."
"Surgeons are neither reimbursed by Medicare, nor any provider for that matter, for foot amputations at rates anywhere close to $50,000, $40,000 or even $30,000. Medicare reimbursements to physicians for foot amputations range from approximately $700 to $1,200."
The group said Obama mischaracterized the reimbursement system by saying physicians get paid "immediately," when Medicare payment delays are common.
"As President Obama continues to pursue the healthcare reform agenda, we implore him to disengage from hyperbole and acknowledge that healthcare delivery can only be improved by recognizing that healthcare is a system in which orthopedic surgeons play a crucial role. With $849 billion of our national economy impacted by musculoskeletal conditions, orthopaedic surgeons provide care that improves lives and puts people back to work."
The CMA added in its statement that it is "committed to reforming our health system to increase access to quality care and reduce rising healthcare costs." But, it continued, "The American people must be able to trust our elected officials and the statements they make regarding healthcare.
"We urge the President to stick to the facts and avoid the kind of misleading and inflammatory rhetoric that would erode the trust and derail our efforts to increase access to quality care and control rising healthcare costs."
The comments were particularly irritating to physicians who are still reeling from the President's recent suggestion that doctors perform many unnecessary tonsillectomies because they get paid more for doing those than for prescribing medications for what might really be wrong with the patient, such as an allergy.
In July, Obama made this statement at an address to the nation:
"Right now, doctors a lot of times are forced to make decisions based on the fee payment schedule that's out there. So if you come in and you've got a bad sore throat or your child has a bad sore throat or has repeated sore throats, the doctor may look at the reimbursement system, and say to himself, 'You know what? I make a lot more money if I take this kid's tonsils out.'
"Now that may be the right thing to do, but I'd rather have that doctor making those decisions just based on whether you really need your kid's tonsils out, or whether it might make more sense to change, maybe they have allergies or maybe they have something else that would make a difference."
One physician who was particularly annoyed with both Obama statements is Ted Mazer, MD, a San Diego ear, nose, and throat specialist.
"His inflammatory and inaccurate comments about physician payments serve the debate on health reform poorly," Mazer says. "He needs to lead the nation with facts, not attacks and misinformation."
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Cheryl Clark is a senior editor and California correspondent for HealthLeaders Media Online. She can be reached at cclark@healthleadersmedia.com. Follow Cheryl Clark on Twitter.
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http://www.healthleadersmedia.com/print/PHY-237492/Obama-Missteps-on-Foot-Amputation-Pay-to-Surgeons
