Becker's Spine Review

9 SPINE LEADERSHIP at will have a profound affect on Medicare dollars and bend the curve." Medicare is also moving toward value-based, risk sharing payment methods. Earlier this year, the Medicare program unveiled plans for bundled payments for hip and knee replacements, and spine may not be far behind. "I think they are going to come out with a similar type of compre- hensive plan for certain types of back procedures," says Dr. Finkenberg. "If they put a ceiling on a one- or two-level fusion, it will be interesting to see how surgeons approach the bundle. NASS thinks it's coming and we'd like to be part of that discussion rather than be handed a decision." Private payers likely won't be far behind aer Medicare begins spine bundled payment for straightforward procedures, such as decompressions, anterior cervical discectomy and fusions as well as single-level lumbar fusion and discectomies. "I think we as surgeons need to find out what our costs really are — what our implants cost, what OR time costs, hospital charges for the inpatient stay and anesthesia charges," says Dr. Hilibrand. "We should be prepared for the hospital to say the bundle is a flat charge for the ACDF and we'll give the surgeon a small percentage. e surgeon can ar- gue their portion is worth more, but they need to know what everything else costs so they can know where to help save money." Most candidates just have per- sonal experiences with the healthcare system. at's why it's imperative for healthcare providers to educate their representatives and support legislators who are working toward improving healthcare for patients. "In the world of spine surgery, there is a perception among the lay medical public that spine surgery, even if it works, doesn't last," says Dr. Hilibrand. "is isn't something that we'll be able to change with 20-year outcomes in clinical trials. It will take a lot of marketing by spine surgeons to make that point. ere are negative stereotypes out there and we have to change that perception or there will be other physicians who prevent us from seeing patients." n Try Your Hand at Politics: 5 Core Concepts for Spine Surgeons By Laura Dyrda B etween managing a practice, treating patients, conducting research and fulfilling com- mittee responsibili- ties most surgeons don't have time to become involved with politics. But politi- cians are increasingly becoming involved with healthcare. "Most surgeons have a general disdain for the political process," says Craig Calle- wart, MD, of Texas Back Institute in Plano. "Elected officials often say one thing and do another, and medicine is relatively free from all that. But the government pays half the healthcare between Medicare, Med- icaid, workers' compensation and Tricare. They pay so much so that they make all the rules. That goes hand-in-hand with having the big payer making the rules, and that inspires me to become involved." Dr. Callewart has served in the state legislature for 16 years and served on his local Congressman's committee for healthcare which drafted the Republican response to certain aspects of the Afford- able Care Act. In addition to his public service, Dr. Callewart has raised money for local candidates and become an expert consultant for elected representatives. "If you want to have an influence on what your elective representatives are doing, start a relationship with that person as a candidate because this is one of the times the candidates are actually listening to constituents before they have to go make decisions," says Dr. Callewart. "Once they are in office, their life is going 100 miles per hour and it's hard to establish yourself as a credible source of informa- tion. If you get to know them during the campaign and establish a rapport, when it comes time to make decisions, they'll call you. That's a gratifying experience." There are times when elected officials called Dr. Callewart for advice and later he saw those thoughts reflected in newspa- per articles and quotes from the legisla- tor. "When I'm one of the 10,000 people voting, I might not have an affect," he says. "But becoming involved in the political process really makes an impact." Here are five key thoughts on maximiz- ing efforts in politics: 1. Support candidates financially — but it doesn't take a fortune. "One of the misconceptions is it takes a lot of money to get involved," says Dr. Callewart. "It does take money, but many politicians also want to hear about what medical professionals have to say and learn more about the basic aspects of delivering care." 2. Get to know your judiciary as well as Congressional candidates. "Your legis- lators make the law, but you have the bu- reaucrats write the law and that may or may not end up fitting the legislative intent," says Dr. Callewart. "We tend to focus on legislators but I also form relationships with local and federal judges because they set the tone for how the law is applied." 3. Team up with other physicians to tackle the issues. Connect with physician colleagues who have similar beliefs about the issues important to physicians. Some physicians from the group can connect with candidates for the local or national legislators and others can connect with legislators and advocacy groups. "If 10 to 20 physicians take a piece of it and rotate in when they have time to connect with elected officials, that can make a big im- pact," says Dr. Callewart. 4. You can make an impact on the broader issues. There are several topics that could have a huge affect on physicians in the future. Bundled payments will likely push forward in many specialties, includ- ing spine, and if it's pushed through there will likely be even more consolidation with physicians being driven toward hospi- tal-employment. "The hospital is paid and then doles out the money for the therapist and physicians for bundled payments," says Kern Singh, MD, of Minimally Invasive Spine Institute at Rush in Chicago. "Some politicians want a single payer system and that isn't palatable for most Americans in concept." 5. Solidify your passion for political realm activity and help representatives understand your point of view. "What drives me is the realization that healthcare spending is 18 percent of the economy, and in Texas, Medicaid is about a third of our budget; nationwide it consumes an equally big amount," says Dr. Callewart. "That's at the forefront of what I'm doing, and I want to make an impact on that go- ing forward." n Dr. Craig Callewart 9 SPINE LEADERSHIP

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