Please send responses to Laura Miller at firstname.lastname@example.org by Wednesday, July 25 at 5pm CST.
Q: How will the Supreme Court's upholding the individual mandate impact spine practices?
Dennis Crandall, MD, Founder and Medical Director of Sonoran Spine Center, Mesa, Ariz.: The success of Obamacare depends on physicians accepting deep discounts, and making room for 30 million additional patients to be seen at those discounted rates. Hiring more PA's and NP's would be our response. Adding more physicians at those reimbursement rates would not be economically feasible.
Ara Deukmedjian, MD, Founder, Deuk Spine Institute, Melbourne, Fla.: There will most likely be more insured going to seek care for elective spine and pain management services and therapy. I anticipate elective spine care volumes will increase because the "newly" insured will want to receive medical care since they are paying the premiums.
Donald R. Johnson, MD, Founder, Southeastern Spine Institute, Mt. Pleasant, S.C.: The individual mandate will not directly impact patient volumes in spine practices however the effect of the many other facets of the Affordable Healthcare Act could be damaging to all medical practices especially surgical practices. Faced with greater uncertainties more surgeons including spine surgeons will become employed and leave or never enter private practice. Physician recruitment is already more difficult for private practices as hospitals offer more money and fewer work obligations right out of fellowship training.
Isador Lieberman, MD, Spine Surgeon, Texas Back Institute, Plano: The individual mandate is meant to ensure health insurance coverage for all and distribute the cost of such over a broad population. Most look at it as adding insured individuals to the healthcare demand pool with the subsequent result of more available patients and therefore more potential patients to care for; I strongly suspect it will have the exact opposite effect. Sure there will be more patients in the pool, (even though a relatively small proportion compared to the size of the current pool) however as insurers standardize their reimbursement coupled with the downward trend in reimbursement value, more physicians will leave the supply side with the subsequent result of less care provided; this is exactly what the authorities want and anticipate so as to cut overall healthcare spending, this phenomena will be borne out in spine practices.
Paul Slosar, MD, President, SpineCare Medical Group, San Francisco Spine Institute: The landscape will be altered across all fields and not likely for the better. Patients will eventually realize that they, individually, will receive fewer medical services (this is the literal translation of "cost savings") in order to expand "coverage" to almost everyone. So if you, as an individual patient, are comfortable with sacrificing your utilization for the "greater good" of society then this is your kind of plan. In my experience with patients, that idea sounds good until you are the one whose actual services are denied as "unnecessary" then the concept becomes less palatable.
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