Becker's Spine Review

8 SPINE LEADERSHIP The 2016 Presidential Campaign Trail: Key Thoughts, Challenges & Issues for Spine Surgeons By Laura Dyrda T he 2016 presidential elections are still a year away, but candidates have been jockeying for the top spot for months already. While the most debated issues for many campaigns focus on the econo- my, immigration, cyber security and terrorism, expect healthcare to take center stage as the sea of candidates dwindles into two frontrunners on either side. "e candi- dates right now are trying to position themselves for popular- ity and exposure," says John Finkenberg, MD, NASS Advocacy Council Chairman and president of the National Associa- tion of Spine Specialists. He practices at Alvarado Orthopedic Medical Group in San Diego. "ey are being coached on healthcare to only go three questions deep: Do we need a universal healthcare system? How do we pay for it? Do we need an insurance mandate? Whether we need to repeal and replace or just tweak current healthcare law never gets discussed, but in reality that's one of the most important issues for how the country will move forward." Republican candidates are more likely to advocate for repealing health- care reform while democratic candidates vouch for changing certain aspects of the law. However, a full repeal and replace is unlikely regardless of who wins the presidency. "e only chance for full health- care reform repeal is if the Republicans controlled the House of Representatives, Senate and presidency and the likelihood of that isn't high, so I'm looking for the candidates to tweak a third of it through defunding and other changes," says Dr. Finkenberg. As a result, when planning for the future providers can assume the ACA framework will be intact. "e central provision around which all of the ACA is based is the concept of coordinating and controlling more of the care by primary care physicians," says Alan Hilibrand, MD, vice chairman of the de- partment of orthopedic surgery/co-direc- tor of spine surgery at Rothman Institute/ omas Jefferson University Hospital in Philadelphia, president of the Cervical Spine Research Society, NASS Advocacy Council Member and Chair of Commu- nications for the American Academy of Orthopaedic Surgeons. "While that's not necessarily a good thing for spine sur- geons, I think it illustrates the need to get out the message about the effectiveness of our treatments and their ability to return people to work and improve the quality of life. And we need to prove moreover that our procedures and innovations are durable." e largest orthopedic and spine specialty societies already have efforts underway to collect data and show how effective surgical treatment can be for the appropriately selected patients. Physicians are publishing their data and research in medical journals and helping develop protocols for treatment in the future. A few of the other key issues can- didates and Congress are talking about include: • Repealing the Independent Pay- ment Advisory Board • Changing the employer mandate • Repealing the medical device excise tax "Where the candidates need to go from here on out is to talk about ways they think they can modify healthcare law to save the popular parts and modify the parts that aren't successful," says Dr. Finkenberg. "If you look at individual candidates, I think Dr. Ben Carson has the obvious advantage for looking from the physician's standpoint on how healthcare works and has an impact on his patients. But he doesn't have a corner on the mar- ket. Hillary Clinton on the democratic side has spent a huge amount of time research- ing healthcare as well." ere are several issues and positions for surgeons to consider at the ballot box next November. However, the issues poised to have the biggest effect include the individual mandate, Medicare reform and competition among providers and payers. 1. Individual mandate: Some favor continuing the individual mandate while others would repeal. Pay attention to alter- natives for the individual mandate in case of repeal and consider how access to care would change compared with the current situation. 2. Competition: Consider whether the policies would encourage or discourage consolidation in the healthcare system, from provider to payer consolidation. Cer- tain policies drive independent physicians to hospital employment, and hospitals to join health systems, which could affect the quality of care. Among payers, some candidates support market competition beyond the health insurance exchanges while others move more toward a single payer system. 3. Medicare: e sustainable growth rate will need repair in the coming years, and whether Medicare can continue is up for debate. CMS is also moving more toward value-based payments and penalizing pro- viders that don't report their quality data. "Whether a Republican or Democrat becomes president in 2016, we'll see some modifications to the ACA that will affect Medicare and payment for physicians will change because the penalties will set in over the next few years," says Dr. Finken- berg. "If you aren't able to participate in EHRs, reimbursement will drop some- where between 2 percent and 8 percent. Dr. Alan Hilibrand Dr. John Finkenberg

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