The decision of the department of orthopaedic surgery at Mayo Clinic, Rochester, Minn. to not participate as a "Center of Excellence" in the total hip and knee replacement demonstration project of the Health Care Financing Administration (HCFA) has attracted a lot of attention.
Bernard F. Morrey, MD, department chairman, refused to participate in the program because, he said, "HCFA's final application form made it crystal clear that the primary focus of HCFA is discounts. In no appreciable way does the process encourage or reward quality service. HCFA only wants to discount further what, in our opinion, is already being discounted in a manner that compromises patient care."
In response to the decision, Donald J. Holtzman, MD, Elizabeth, N.J., wrote:
"I was very proud to read in the recent AAOS Report of February 1997 that you will not participate as a 'Center of Excellence.' You and I know that it's merely a statement for lowest possible reimbursement with the least amount of service being rendered. If more physicians of note would have the guts to avoid participation in these noxious programs they would probably not get off the ground in an adequate fashion.
Similarly, if more physicians had the guts to avoid the very noxious HMOs and other similar nefarious plans, medicine would probably be in a far better situation today. As you undoubtedly know the outlook for private practice is dismal and getting only worse by the day. Unfortunately, we can no longer look to the government for fairness or equitable treatment. Those words are no longer considered part of the economic equation.
I applaud you for your stand and would hope that other orthopaedic surgeons of similar repute would have the intestinal fortitude to do what you have done, setting an example for the entire country. Hopefully, organized medicine may do more for us if they see a ground swell of opposition in the physician ranks to the current socioeconomic mess."