Atrait that most Physicians share is the desire to serve those in need. But there are a special few that expand that passion to seek to change the world around them and far from home. Such a Physician is Dr. Marcelo Hochman, an independent solo pediatric facial plastic surgeon who practices in Charleston, South Carolina. He has specialized in the treatment of congenital vascular anomalies. Dr. Hochman could have been content putting smiles on the faces of facially deformed children in Charleston, but he had his eye on sharing his surgical techniques with the world. Starting in 1995, Hochman began to travel as a member of a humanitarian and educational surgical exchange program known as Face-to-Face.
Hochman worked with colleagues at Ekaterinburg’s Bonum Center, a multidisciplined children’s hospital supporting the Autonomous Republic of Sverdlovfk of post-Soviet Russia. The experience enlightened Hochman as he noted the cultural and material differences associated with their Russian counterparts. The exchange generated mutual respect for Russian and American medical personnel. “Many good friendships have emerged through this type of interaction,” said Hochman, who previously traveled to Honduras and Mexico for Face-to-Face.
Born in Argentina, Hochman grew up in Venezuela and became a naturalized U.S. citizen in the 70s. Seeing how his work with Face-To-Face could literally change the world, Hochman began to think through ways to change his own corner of the world. And although Dr. Hochman’s South Carolina practice continues to thrive and provide invaluable service to the community, he decided that he wanted to be part of the catalyst to tangibly improve the practice of Medicine by developing a plan to demonstrate how Physicians could work together to bring about change. He now works with local and state medical societies to push for passage of legislation that would make it easier to expand services in communities, free Physicians from onerous non-compete clauses in their contracts and reward Physicians with tax deductions for services they provide to charitable organizations. As such, he currently serves as the president of the Charleston County Medical Society and chair of the Coalition to Repeal CON (Certificate of Need).
In an episode of The Accad & Koka Report podcast this past June, Dr. Hochman explained how he became part of an organizing effort to improve health care in South Carolina, starting with working toward the repeal of the certificate of need. “The certificate of need is basically a law that says that the state has to give permission for the building of certain facilities or the provision of certain services. This started back in 1974 and 1973, when the federal government told the states that as a condition of receiving grants from the government, that certain conditions needed to be met. They said if they were going to give money to the state, the state had to make sure that there wasn’t duplication of efforts, that the costs were controlled, that there were alternatives for treatment, and the quality was maintained. By 1985 or so the federal government realized that none of those things were actually happening. So, the certificate of need, as well intentioned as most things are, really did not do what it was intended to do. Some states immediately revoked the requirement and other states continued to require it.”
North Carolina and South Carolina are two of the states that still have a CON requirement, which means that if a radiologist in North Carolina wanted to open his own imaging facility, he’d have to get permission from the state by proving there was a need for the facility. “Well, guess who doesn’t want to have another facility built? The people who already have a certificate of need,” Hochman told Accad & Koka. “So, if you’re a hospital who already has imaging centers, then you don’t want an independent imaging center opening across the street. The incumbents get to vote on who gets a certificate of need or not.”
Dr. Hochman has seen the impact of the CON in South Carolina. “In South Carolina, we have fewer hospital beds than we need for the population that we have. The state spends twice as much per capita on healthcare, and building facilities [than] other states, so the state is actually spending more money on fewer things, because that’s what happens when you limit the supply.”
Despite the odds, Dr. Hochman and his group were able to introduce legislation to repeal CON in South Carolina, but they have a long road ahead of them. Hochman revealed on the same podcast, “We had a hearing where five doctors went to testify in favor of the legislation before the Ways and Means Committee where this bill was sitting, and thirty hospital administrators were there to oppose us. The real difficult part is getting it through the legislature.”
Hospital administrators aren’t the only ones resistant to change. Nearly half of Physicians are employees of hospital systems, and it’s difficult to generate enthusiasm and support among those Physicians for expanding the health care marketplace if it is perceived that their own jobs will be in jeopardy as a result. And many of these Doctors are hampered by non-compete clauses in their contracts, which restrict their professional mobility. That’s why the elimination of non-compete clauses is tied so closely to the repeal of the certificate of need in states like South Carolina.
And that brings us to Dr. Hochman’s take on compensation for pro bono medical services rendered. If that sounds unreasonable, consider this: hospitals are often applauded for their charitable efforts to treat Patients who cannot afford their services. What most people don’t know is that hospitals are actually indirectly compensated for this “charity” work in the form of tax incentives. However, the Physician who treats the Patient does not benefit in any way. It has a chilling effect on Physician volunteering Dr. Hochman revealed. “In South Carolina, we have a far less amount of charitable care being done. It’s because as a doctor, if you are employed, and you want to treat a patient for free, they won’t even get in the door. But the hospital goes through all these machinations [to treat this same patient as a ‘charity case’] and ends up getting reimbursed. But then that same doctor gets essentially nothing. If, however, Physicians had the ability to practice wherever they wanted to, and had an incentive [such as tax deductions for what the normal compensation would be for such services or assign a monetary value that could be counted as a charitable donation] to provide charity care, all of a sudden, the whole concept of private charitable care would improve.”
As Dr. Hochman navigates the troubled waters of trying to get their legislation passed and implemented, he admits that some of his resolve is fueled by his desire to improve the lot for one particular aspiring Doctor. He told Accad & Koka, “My disclaimer for all of this is that I have a very, very vested interest in doing all this. My son just got into medical school, so I want to make sure that when he gets out of this whole thing, ten or eleven years from now, that he has some options.”
And pursuing those options, which include professional mobility and freedom, greater Patient access to care, and an environment that encourages philanthropy and good works have become Dr. Hochman’s professional crusade.
