Issue link: https://beckershealthcare.uberflip.com/i/772947
currently in place and will not be easily repealed or replaced in the next two to three years. e GOP Congress and administrative branches will make modifications to the current rules more possible. CMS has already made modifications that will allow more options for everything from negative adjustment to reimbursement. e checks and balances built into our political system will still make legislative change slow as major healthcare legislators are not viewing our healthcare issues the same way as our incoming president. It will be important for the GOP to look carefully at which portions of the current law should be modified first as our ultimate goal is to benefit all members of our society and not just the medical sector. e eyes of the world will be on us at this very important time in history and it will be our obligation as healthcare professionals to usher in a system that provides the highest quality of care at an affordable cost. I am confident that we are up to the task and can make the necessary adjustments to remain the premiere healthcare system in the world. Sheeraz Qureshi, MD, Mount Sinai Medical Center (New York): I am hopeful that this election's results will mean that the Cadillac tax will be repealed so that employers can continue to offer good coverage to their employees without paying a heavy penalty. I am also hopeful that we can find a way to significantly improve Obamacare while maintaining the positives such as providing coverage to those who weren't covered otherwise. Mick Perez-Cruet, MD, Michigan Head & Spine In- stitute (Southfield): I think the next four years under Donald Trump will see improvements in healthcare management and advancement of innovation. Allowing insurance companies to compete across state lines should help to bring the cost of healthcare premiums down. Perhaps he will tackle the liability issues that add to the cost of healthcare delivery. However quality healthcare will continue to be costly but worth it. Aer all, your health is your most valuable asset. William Tally, MD, Athens (Ga.) Orthopedic Clinic: I think anyone who makes any predictions about changes to the trajectory of healthcare is guessing. Undoing Obamacare will be difficult on the ground level. Changes can be made from a legislative perspective but so many of the onerous items in that bill are already implemented and will be difficult to change. e limiting factor will be Trump's ability or inability to work with Congress. I think he's a lot like spacemount; it's a heck of a roll coaster, you just don't know where it's going. Richard Kube, MD, Prairie Spine & Pain Institute (Peoria, Ill.): Everything is going to be speculative. We are pretty sure what would have probably happened had Hillary been the president elect; it would have been a continuation of existing policies. With Donald Trump, things are somewhat speculative because he doesn't have a political record. From a business standpoint and what he indicated in speeches, he is for decreasing regulations. He has no respect for Obamacare and now he has the House and Senate behind him. We will see some degree of repeal of Obamacare, and without the administrative regulation, we could see a positive impact on our practice. Decreased regulation gives us more time to spend with patients in- stead of paperwork or talking to people who have nothing to do with the care process. From our business standpoint, insurance rate sky- rocketed since Obamacare; anything that puts a check on that will help our bottom lines as well. In our practice, insurance rates went up 12.5 percent; even a small practice that's five figures. n 11 SPINE LEADERSHIP The CORE Institute's Condition- Based Bundles — A New Approach to Eliminating Waste By Laura Dyrda T he Harvard Business Review profiled Phoenix-based The CORE Institute's new condition-based approach to eliminating unnecessary care as an alternative to procedure-based bundled payments. In 2009, The CORE Institute took on financial risk for the physician-related med- ical expenses based on a per member per month fee from the insurance company that totaled around 20 percent of the physician medical expense for care. Now, the practice handles the entire diagnosis-based spend, meaning the provider can choose alternative therapies to surgery. The practice covers all scenarios, whether it's an MRI, hos- pitalization after surgery or medication for musculoskeletal pain. The article highlights three key notes about the diag- nosis-based payments: 1. The CORE Institute designed the condition-based bun- dle to keep patients healthy and prevent further issues. The practice has evidence-based protocols and patient pathways to optimize care as well as a postoperative blood clot clinic to prevent patients from returning to the ER with blood clot-related issues after surgery. 2. The condition-based model incentivizes physicians to select high value treatment, whether it's operative or nonoperative. 3. The CORE Institute physicians can choose the site of ser- vice — a hospital, surgery center or another facility. The CMS bundled payment program currently focuses on hospital admissions, a more expensive site of service. The practice implemented analytics and practice manage- ment tools to track patient information and automate func- tions when possible to remain efficient, effective and com- pliant. The CORE Institute's IT has become so sophisticated they now have launched predictive analytics tools with the ability to identify the most successful site for patients to re- cover from surgery, among other uses. Since beginning the condition-based care program in 2012, the organization has reduced per member per month costs by around 50 percent with some at-risk patient populations and showed their costs are around 30 percent lower than others in the region. Savings primarily came from fewer readmissions af- ter surgery and discharging fewer patients to nursing homes. "For medical conditions or sets of related medical condi- tions that can easily be treated on their own, the advantage of the condition-based payment model relative to the glob- al payments model is that the provider is only financially ac- countable for the types of diagnoses that it can reasonably influence," wrote David J. Jacofsky, MD, CEO and founder of The CORE Institute, and Derek A. Haas, project director of the Value-Based Care Delivery initiative and Harvard Busi- ness School fellow, in the article. n