Issue link: https://beckershealthcare.uberflip.com/i/170079
Sign up for Becker's Orthopedic, Spine Business & Pain Management E-Weeklies at www.BeckersOrthopedicandSpine.com or call (800) 417-2035 Another provision of ACA, the Independent Payment Advisory Board has virtually unchecked authority to reduce healthcare costs, and will have as its primary focus physician reimbursement levels, and a reduction in federal spending for pharmaceuticals and medical devices. Finally, both government and commercial payors are beginning to exert downward pressure on utilization of high-cost services (like spinal surgeries), coupled with a reduction in reimbursement rates for physicians' services. Public and private payors, spurred by provisions in the ACA, have increased their reliance on so-called "evidence-based medicine." In theory, this makes sense; of course physicians should base their clinical decisions on all available evidence. The challenge in spine surgery is what constitutes evidence; while payors insist that the best evidence only comes from randomized controlled trials, spine surgeons understand that RCTs are oftentimes impossible to conduct in surgical scenarios. This results in a far greater scrutiny of spine procedures once considered the standard of care, and forces surgeons to continually justify the care decisions they make. We remain hopeful that the implementation of the ACA will not adversely impact our patients' access to medically appropriate care. Stephen Hochschuler, MD, Founder, Texas Back Institute, Plano: The re-election of President Obama means ObamaCare will remain in place. Unfortunately there is so much within this 2,700 page document that only time will tell what impact this will have. I personally have great concern for patients and physicians. Neither, for various reasons, had any significant input to this healthcare legislation. The AMA, as usual was asleep at the wheel. Both patients and physicians, I believe, will experience new regulations which will restrict choice. More likely than not, bureaucrats will make regulatory decisions without the knowledge or input of treating physicians. Through the years Texas Back Institute has trained more than 100 fellows, many of whom still have significant debt. Although I personally thoroughly enjoy the practice of spine surgery my concern for the Millennium surgeon is what's mentioned above. There will be many more challenges to face. Hospitals will continue to purchase physician groups. 47 Some aspects of the ACA are superb. For example, giving insurance to everybody, not being able to take insurance away if you get sick and being able to move from job to job and take your insurance with you. There are other aspects that will need to be modified and improved, for example the Independent Payment Advisory Board. A. Nick Shamie, MD, American College of Spine Surgery President: It's very difficult to predict how any healthcare change would impact spine surgeons. One thing is for certain: The healthcare system will change in this country. We have a growing population and an increased demand for healthcare in this country. The costs have continued to escalate year after year and we need to reign in the costs of healthcare especially in our current economic environment. As physicians, we should all expect decreased pay from government and private payors per each patient care delivered. Specialty and elective care will not be reimbursed as well as it is today. Patients will have to pay out of pocket for elective care (much of spine surgery falls under this category). I believe all of this will translate into an increase in efficacious outpatient minimally invasive procedures with lower per-procedure costs that patients can pay for out of pocket. Jeffrey Wang, MD, UCLA Spine Center: Although the election process will definitely influence the future of healthcare and certainly spine surgeons have been very interested in the outcome, in reality, there are changes that have been set in place for some time that would likely have been implemented, regardless of the election results. Placing more demands on the surgeons and certain requirements in the near future would likely have been mandated. I think the fact that President Obama was re-elected means that the process may be more transparent in the sense that many surgeons were preparing for the changes that he set in place, and now we know that he will likely push these forward. However, healthcare is changing and will continue to change, regardless of the outcome, and we need to make sure that we understand these changes, prepare for these changes and try to anticipate the changes that will likely come in the future. Clearly there is a need for more efficient spending of healthcare dollars and a requirement to show evidence to support our treatments. And, improving patient care and outcomes will be a top priority. n Accountable care organizations will initially try to play a major role. I believe insurance companies, hospital companies, plaintiff malpractice attorneys, drug and implant companies will initially make more money. Physicians, on the other hand, will work longer hours with increased documentation, increased overhead costs and less take home pay. I also believe that as Medicare and Medicaid grow, physicians will try to limit access but the government will pass a law that requires such care or one will lose their license. Advertising Index What alternatives might help adjust this scenario? More surgery will be done on an outpatient basis. With this in mind, physicians would do well to supplement their income by ownership in surgi-centers. In addition another physician-owned model which not only helps control implant costs by removing the middleman, similar to iTunes, Amazon and Netflix but also contracts for "bundled payments" and "episodes of care" should be considered. Eventually this could become a physician-owned insurance company. Blue Chip Surgical Partners. JLeland@bluechipsurgical.com / www.bluechipsurgical.com / (513) 561-8900 (p. 10, 35) Perhaps my last consideration, especially in those states that have NOT had malpractice reform is for physicians to investigate an offshore, physicianowned insurance company that only settles legitimate cases for a legitimate fee. How this will play out in the long run is yet to be determined. Charles Mick, MD, North American Spine Society President: It is time for all stakeholders in healthcare to look beyond self interests and to work together and implement the Democratic experiment in healthcare reform. Nobody knows the end result, but all of us know that healthcare reform is needed. We need to improve care coordination and quality, and we need to reduce costs. The Democrats have won, and we have been given a message that the public wants to move forward with their plan. Note: Ad page number(s) given in parentheses Amedica / US Spine. szeiger@amedicacorp.com / www.amedicacorp.com / (801) 839-3506 (p. backcover) Esaote. info@esaoteusa.com / www.esaoteusa.com / (800) 428-4374 (p. 4) Medical Marketing Solutions. www.medmarketing.com / (623) 201-1700 (p. 2) Meridian Surgical Partners. bbacon@meridiansurg.com | khancock@meridiansurg.com /www.meridiansurgicalpartners. com / (615) 301-8142 (p. 7) National Medical Billing Services. adenad@asccoding.com / www.asccoding.com / (866) 773-6711 (p. 42) Neurologica. www.neurologica.com / (877) 564-8520 (p. 25, 26, 27, 28, 29)