VOLUME 26, ISSUE 2
Udaya B. Padakandla, MD History Editor
Cheers to Tillmann Hein:
A Physician, An Advocate, a Past President of the TSA
Dr. Tillmann Hein was the President of TSA during 2011-2012. He is the man responsible for rejuvenating the History Committee within the TSA. That’s not to belittle the monumental work done by Drs. Charles Tandy and Bob Krause, who created the History Committee at TSA in the 1960’s, or the late Dr. Buddy Giesecke who co-chaired the History Committee (along with Dr. Tandy) in the 1990s and 2000s.
In this issue, we will take a look at Dr. Hein and his contributions to the Society. I sat down with him at his office one day, and interviewed him at his table, against a backdrop of his favorite paintings collection.
There were at least four time periods when his advocacy efforts bore fruit in his career. The first one was in the 1990’s when Centers for Medicare and Medicaid Services (CMS) was setting rules for the then new policy on Monitored Anesthesia Care (MAC) for breast biopsies. In addition to the electronic documentation, CMS was also about to require extensive paper documentation. In response to presentations to Surgical Societies and the Coleman (independent, non-profit) Foundation by Dr. Hein and his Economics Committee at TSA, there were numerous phone calls to the politicians and regulatory agencies at the Federal Government. Subsequently, CMS removed the requirement for paper documentation, a move that saved $10 million per year for anesthesiologists.
The second episode happened shortly thereafter, when Texas Workers’ Compensation Commission decided to reduce the compensation to anesthesiologists to $22 per unit based on Medicare rates. TSA Economics Committee, under the direction of Dr. Hein, commissioned an actuarial study (paid for by large private groups in Texas), that showed that the average payment to anesthesiologists should be $50-53 per unit, as determined by Millman and Associates. Once again, based on a forceful presentation in front of a crowded room in Austin, Dr. Hein says, “the rate for anesthesiologists with Workers’ Comp was set at $45 per unit.” In essence, it meant an increase in the payment toward anesthesiologists in Texas to the tune of $10 million per year.
The third significant contribution came in 2009, at the height of the heated U.S. Congress debate on the Affordable Care Act. The initial Bill (HR 3200) contained provision for a robust public option. The public option plan was to be applied to all those who were currently uninsured or lost insurance, or were not qualified for Medicaid. It was going to be the middle portion between Medicaid and employer sponsored health insurance plans. The way HR3200 was structured, the vast majority of patients would be forced into this public option plan, and the public option plan would pay at Medicare rates. If that had happened, anesthesiologists across all of America would have seen their take-home pay reduced to 25% of what it was at the time. “At that time, my practice had opened a new office in South Dallas and we had invited Congresswoman Eddie Bernice Johnson to cut the ribbon,” explains Dr. Hein. “After she had done that ceremoniously, I asked her to come to a small conference room where I knew that I had no more than five minutes possibly and had carefully crafted visual material explaining to the congresswoman the devastating effects that this public option plan would have on American Anesthesiologists; and proved that with the GAO study that demonstrated that anesthesiologists only made 30% by Medicare in comparison to market rates and in comparison to other physicians who get paid about 80%. She was appalled to hear that, and in
