December 2004 Bulletin

Iraq follow-up

I would like to update your readers on the Iraqi Medical Specialty Forum Project. You have already received a report from Rick Wilkerson, DO, of the February 2004 event in Baghdad (Bulletin, June 2004). On September 25 – 26, 2004, Dr. Wilkerson and I attended a follow-up meeting in Washington D.C. Also in attendance were the alumni of the Baghdad meeting as well as representatives from the federal government, the military, professional medical organizations and other interested parties.

The prestigious list of attendees included Senate Majority Leader William Frist, MD; Surgeon General Vice Admiral Richard Carmona, MD, MPH, FACS; Yank Coble, MD, president of the World Medical Association, and James N. Johnson, FRCS, council chairman of the British Medical Association.

The purpose of the meeting was to determine next steps. We wanted to understand our respective capacities and gauge the interests of further projects. We also took the opportunity to lobby various governmental organizations.

We agreed to call ourselves the “Medical Alliance for Iraq” and developed the following mission statement: To advise, promote and assist in the advancement of health care in Iraq and to provide professional support to Iraqi physicians.

We still believe that it is important for American and Coalition medical societies to engage themselves with our Iraqi colleagues. We are planning a follow-up meeting in Iraq, possibly Kurdistan, in 2005. We were pleased to discover that the Ministry of Health and Coalition forces have prioritized a “Medical Learning Center” within the Green (International) Zone. This project is a direct extension of the Iraqi Medical Specialty Forum Project and the other educational projects started by Colonel Donald Gagliano as CJTF-7 Surgeon. The opportunity will soon exist for visiting educators to teach and conduct courses in Baghdad.

From the feedback from the Iraqi attendees and based on the current realities of Iraq, we feel that international medical societies can best assist our Iraqi counterparts through education. Temporary/Honorary memberships to U.S.-based societies have been noted as particularly desirable. Through these provisional memberships, our Iraqi colleagues can gain access to Web-based educational material with minimal expenses to the contributor.

A suggestion has been made that international societies donate out-of-print or unsold educational materials. It can be assumed that computer-based materials are compatible. Rick and I have identified a potential charity that can assist with shipping. Rick has single handedly acquired nearly $100,000 worth of external fixators. The first shipment has already arrived in Baghdad.

Other international charities are looking for individuals or organizations to partner with on special projects in Iraq. For instance, Project HOPE is building a large children’s teaching hospital in Basra and is looking for academic collaborators upon its completion. This is a highly visible project, funded in great part through USAID, but there are other “lesser” ventures in progress.

I have recently learned of the Iraqi nominee to attend the AAOS 2005 Annual Meeting in February, Dr. Thamer Hamdan. This is a wonderful gesture by the AAOS and an example of the types of engagements we are trying to foster. Rewarding our Iraqi colleagues for organizing into democratic, open and inclusive organizations is critical for their successful development. It is important that legitimate organizations within Iraq be supported.

We understand the current turbulence in Iraq makes it difficult for any national organization to directly sponsor the Medical Alliance for Iraq. By acknowledging our organization as legitimate, noting our future efforts as worthy and prudently using organizational prestige and communication networks, we hope to identify those individuals and organizations that are capable of participating today. In the future I am sure that the AAOS will have a direct relationship with the Iraqi orthopedic counterpart.

Promotion of the Iraqi Medical Specialty Forum through the societies was critical to our prior successes. I would like to personally thank the staff of the American Academy of Orthopedic Surgeons for their efforts. The AAOS has been a leader among societies. I ask for your continued support for this worthy mission.

Timothy A. Gibbons, MD

Mason City, Iowa

RVUs and you

I read the article by James J. Hamilton, MD, (October 2004 Bulletin) about RVUs. In today’s health climate, in addition to the medical practice of orthopaedics, we have unfortunately been placed in the role of businessmen. RVUs are relative values that are being used by Medicare to reimburse fees nationwide and more frequently by third-party payers. Dr. Hamilton is correct in that they are based on three components; physician work, malpractice cost and overhead expense.

While Dr. Hamilton appropriately points out that these numbers are ultimately adjusted to accommodate different geographic areas, malpractice costs and practice overhead expenses, what he did not mention is that the actual physician work component also is adjusted per geographic region. For example, the total amount that Medicare will pay for the work of a physician for a total hip replacement is more in Chicago than in Central Illinois. I personally have always been mystified as to how Medicare views the work done in some geographic areas for an identical surgical procedure to be different depending on the area of the country in which we live.

The second comment is on how he would utilize RVUs to manage a practice. Although it is a very quick way to get some basic data, using current RVUs to decide whether to accept or reject a contract can lead to substantial errors in the management of your practice. Before deciding to accept or reject a contract, we need to pay attention to our fixed and variable costs. Although, as in Dr. Hamilton’s example, if our cost per RVU is $60.00, the incremental cost of seeing one more patient might be an additional practice cost per RVU unit of only $5.00 or $10.00. We would also need to consider whether we would be able to accommodate any new patients or, by accepting the contract, would we have to displace some of our current patients. If we displace the current patients, is the new contract better paying than some of the payers we currently are accepting? The accepting or rejecting of a contract is much more complicated than looking at a simple RVU number.

Jeffrey F. Traina, MD

Peoria, Ill.

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