Despite the uncertainty associated with today's healthcare system, John Caruso, MD, a neurosurgeon with Parkway Neuroscience & Spine Institute in Hagerstown, Md., believes that now is a great time to be practicing medicine. His optimistic outlook focuses on the potential for positive change and physicians' ability to drive that change. He has decided to become involved in affecting positive change in the healthcare system and he encourages other medical professionals to do the same.
"When the healthcare environment gets rough, you can't put your head in the sand," says Dr. Caruso. "We're seeing two different scenarios play out on the micro and macro levels of healthcare: People are either praying things don't change or they are preparing for the worse. Surgeons need to take steps depending on their unique and personal perspective to position themselves for success. These steps include taking employment at a hospital, giving up cases that aren't profitable or cutting back practice staff. The decisions surgeons must make have huge implications for themselves, their employees and their patients."
Here, Dr. Caruso discusses the biggest challenges and opportunities for surgeons in today's healthcare environment.
Q: What are the changes in the healthcare system that spine surgeons should be most concerned with right now?
Dr. John Caruso: In January, we may likely see reimbursement going down, which means there will be access to care issues. Surgeons need to consider how they are going to deal with the reimbursement decline. Are you going to get involved in cutting out some of the fat? Are you going to play a part in making changes to the system? Physicians need to buck up and say 'Yes, I will be involved in cutting costs but will fight to maintain healthcare quality and accessibility.'
In cutting costs, we also have to think about whether the new equipment or expensive implant will work better for the patient. New technology must be able to deliver outcomes proving it is better, which sounds great, but it isn't so easy to obtain this type of information. The other big thing physicians need to advocate for is tort reform which effects how we practice care delivery. We need to challenge some of the influences that effect how we practice. Medicine as an industry has propped up by the economy but now the economies are changing, and physicians must have a seat at the table to champion their causes and their patients' causes.
Q: Most surgeons would agree that medical professionals should be part of the overhaul of the healthcare system, but many don't become involved in advocacy efforts. What is holding them back?
JC: Physicians go into medicine because they have an altruistic drive to help people. What has discouraged physicians from becoming more active is they don't see the strength they have. Our strength is in what we do: taking care of people. We aren't looking at the numbers and making decisions based on profitability. If we look at ourselves collectively, we have market mover strength and there are things we can do to maximize that position: get engaged, improve overlap in redundancy, integrate with other providers and show payors what we can achieve for patients.
American medicine has disengaged surgeons from our non-surgical colleagues and made it hard for us to get things done. We need to think about how we can use different business models to improve our costs by leveraging what we do: provide good quality care. We need to get back to the concept that healthcare isn't a right; it's a privilege. There are people dying from lack of healthcare all around the world. We have a great concept that can improve the healthcare system if we become engaged in it. Now is the time to step up and form relationships with different stakeholders in the healthcare system to provide better patient outcomes and improve how we practice.
Q: It's a challenging time for surgeons right now because the healthcare system is in a constant state of change. How does all this uncertainty impact spine surgeons?
JC: It has both positive and negative impacts, but I really believe this is a great time to be a physician because we have the chance to take back the healthcare system. We've been held hostage by a third-party payor system and lost control of decisions at a hospital level. The strategy to overcome these unique challenges encompasses not only what will happen at a local or regional level, but also what is happening at the national level. The market will always dictate the healthcare industry, and the question you have to ask yourself is: Are you prepared as a physician or physician group to become part of the answers to these challenges?
Q: In your experience, what concrete things can spine surgeons do to become part of the 'answer' for these challenges?
JC: One of the most important things we can do is prepare appropriately for the future. Physicians must understand that medicine is a business. If we want to practice the way we want to practice, we have to adopt a business mindset. You cannot practice medicine without understanding that you are in the business of medicine. As I've tried to grow my practice, I found that you have to have a good business understanding and your business models have to be flexible. There is more to being profitable than just working harder and seeing more patients to pay the bills.
Personally, I am looking to apply the idea of centers of excellence to spine care and musculoskeletal care. That doesn't mean just providing all the standard spine care practices under one roof; we are talking about truly trying to improve our group by our physicians helping each other to improve how we take care of our patients. We have to be able to use our position of strength to help each other out and conduct a business that will most benefit our patients. I really encourage physicians to find ways to enter the discussion about healthcare improvements and not rely on legislative or administrative solutions. We have to have faith in ourselves as physicians and trust that we will champion our patients over all others.
Q: How can surgeons begin engaging with their colleagues and fellow healthcare professionals to affect change in the healthcare system?
JC: Physician engagement involves changing the dynamics of how you practice and think. As physicians, we rarely participate in legislative side of organized medicine, but you have to spend money on politically active associations. Surgeons should also engage with state and nationals societies and connect with both academic and clinical private practice. Healthcare reform changes are being thrust upon us now and it'll either unify or fracture us further. My premise is that we have the power to make things happen if we work collectively. Spine surgeons and musculoskeletal specialists all have the same challenges, so that should bring us together. We must improve the cost effectiveness of how we practice but not relinquish access or quality.
Related Articles on Spine Surgery:
10 Cost Benchmarks for Outpatient Cervical Spine Surgery
Leading the Charge for Outpatient Spine Surgery: 5 Points From Dr. Walter Eckman
Where Spine Research is Headed: 5 Points From Dr. Frank Phillips
"When the healthcare environment gets rough, you can't put your head in the sand," says Dr. Caruso. "We're seeing two different scenarios play out on the micro and macro levels of healthcare: People are either praying things don't change or they are preparing for the worse. Surgeons need to take steps depending on their unique and personal perspective to position themselves for success. These steps include taking employment at a hospital, giving up cases that aren't profitable or cutting back practice staff. The decisions surgeons must make have huge implications for themselves, their employees and their patients."
Here, Dr. Caruso discusses the biggest challenges and opportunities for surgeons in today's healthcare environment.
Q: What are the changes in the healthcare system that spine surgeons should be most concerned with right now?
Dr. John Caruso: In January, we may likely see reimbursement going down, which means there will be access to care issues. Surgeons need to consider how they are going to deal with the reimbursement decline. Are you going to get involved in cutting out some of the fat? Are you going to play a part in making changes to the system? Physicians need to buck up and say 'Yes, I will be involved in cutting costs but will fight to maintain healthcare quality and accessibility.'
In cutting costs, we also have to think about whether the new equipment or expensive implant will work better for the patient. New technology must be able to deliver outcomes proving it is better, which sounds great, but it isn't so easy to obtain this type of information. The other big thing physicians need to advocate for is tort reform which effects how we practice care delivery. We need to challenge some of the influences that effect how we practice. Medicine as an industry has propped up by the economy but now the economies are changing, and physicians must have a seat at the table to champion their causes and their patients' causes.
Q: Most surgeons would agree that medical professionals should be part of the overhaul of the healthcare system, but many don't become involved in advocacy efforts. What is holding them back?
JC: Physicians go into medicine because they have an altruistic drive to help people. What has discouraged physicians from becoming more active is they don't see the strength they have. Our strength is in what we do: taking care of people. We aren't looking at the numbers and making decisions based on profitability. If we look at ourselves collectively, we have market mover strength and there are things we can do to maximize that position: get engaged, improve overlap in redundancy, integrate with other providers and show payors what we can achieve for patients.
American medicine has disengaged surgeons from our non-surgical colleagues and made it hard for us to get things done. We need to think about how we can use different business models to improve our costs by leveraging what we do: provide good quality care. We need to get back to the concept that healthcare isn't a right; it's a privilege. There are people dying from lack of healthcare all around the world. We have a great concept that can improve the healthcare system if we become engaged in it. Now is the time to step up and form relationships with different stakeholders in the healthcare system to provide better patient outcomes and improve how we practice.
Q: It's a challenging time for surgeons right now because the healthcare system is in a constant state of change. How does all this uncertainty impact spine surgeons?
JC: It has both positive and negative impacts, but I really believe this is a great time to be a physician because we have the chance to take back the healthcare system. We've been held hostage by a third-party payor system and lost control of decisions at a hospital level. The strategy to overcome these unique challenges encompasses not only what will happen at a local or regional level, but also what is happening at the national level. The market will always dictate the healthcare industry, and the question you have to ask yourself is: Are you prepared as a physician or physician group to become part of the answers to these challenges?
Q: In your experience, what concrete things can spine surgeons do to become part of the 'answer' for these challenges?
JC: One of the most important things we can do is prepare appropriately for the future. Physicians must understand that medicine is a business. If we want to practice the way we want to practice, we have to adopt a business mindset. You cannot practice medicine without understanding that you are in the business of medicine. As I've tried to grow my practice, I found that you have to have a good business understanding and your business models have to be flexible. There is more to being profitable than just working harder and seeing more patients to pay the bills.
Personally, I am looking to apply the idea of centers of excellence to spine care and musculoskeletal care. That doesn't mean just providing all the standard spine care practices under one roof; we are talking about truly trying to improve our group by our physicians helping each other to improve how we take care of our patients. We have to be able to use our position of strength to help each other out and conduct a business that will most benefit our patients. I really encourage physicians to find ways to enter the discussion about healthcare improvements and not rely on legislative or administrative solutions. We have to have faith in ourselves as physicians and trust that we will champion our patients over all others.
Q: How can surgeons begin engaging with their colleagues and fellow healthcare professionals to affect change in the healthcare system?
JC: Physician engagement involves changing the dynamics of how you practice and think. As physicians, we rarely participate in legislative side of organized medicine, but you have to spend money on politically active associations. Surgeons should also engage with state and nationals societies and connect with both academic and clinical private practice. Healthcare reform changes are being thrust upon us now and it'll either unify or fracture us further. My premise is that we have the power to make things happen if we work collectively. Spine surgeons and musculoskeletal specialists all have the same challenges, so that should bring us together. We must improve the cost effectiveness of how we practice but not relinquish access or quality.
Related Articles on Spine Surgery:
10 Cost Benchmarks for Outpatient Cervical Spine Surgery
Leading the Charge for Outpatient Spine Surgery: 5 Points From Dr. Walter Eckman
Where Spine Research is Headed: 5 Points From Dr. Frank Phillips