Here three surgeons discuss the policy changes they would make to improve the current healthcare industry landscape.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.
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Question: What healthcare policy changes would you make if you could?
Ray Oshtory, MD, MBA, Pacific Heights Spine Center, San Francisco: Allow Medicare to collectively bargain drug prices for Medicare Part D benefits. Currently, Medicare sets payment rates for physicians, and other private insurers use Medicare's rates as a benchmark for setting their rates. That is why physician reimbursement rates have not risen over the past two decades, for better or worse.
Similarly, if Medicare were allowed to collectively bargain drug prices, other insurers would surely use Medicare's rates as a benchmark, thereby driving down the cost of pharmaceuticals, and likely eventually implants and devices as well, if a carve out for these products was implemented. That one simple policy change would prevent the prices of pharmaceuticals from skyrocketing, examples of which have been filling the media lately. As a point of reference, Medicare Part D's budget for 2015, which accounts for only outpatient prescription drugs, was equivalent to Medicare Part B's budget for 2015, which accounts for all payments to all doctors for all services, inpatient and outpatient.
Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: I would make payers contractually obligated to pay on time. In short, when medical authorization is obtained from a private payer, it is considered a contract for payment. Payers would then not be able to disconnect the authorization and payment process. So, they cannot then ask for the same documents four or five time or make up reasons to not pay, such as the patient was not covered at the time of service, etc., and just write the check.
The other thing would be tort reform. Without a doubt, I thank MACRA will fail as doctors will and should continue to practice defensive medicine. The move toward disincentivizing doctors from "use resources" will not work and doctors will not sacrifice patient well-being or their careers.
Vladimir Sinkov, MD, New Hampshire Orthopaedic Center, Nashua: Medical liability reform — caps on non-economic damages have been shown to work well in reducing frivolous lawsuits in several states. Nationwide adoption of those caps would be a good first step. Healthcare courts, instead of the regular jury trials, would also be helpful. Finally, a great incentive for discouraging the start of a frivolous lawsuit would be having the plaintiff pay defendant's legal fees and lost time out of work if the plaintiff loses.
Additionally, deregulation of the health insurance market, removal of their anti-trust exemption clause and allowing insurance companies to compete across the state lines would encourage true market competition and drive down costs and increase efficiency. This would greatly enhance our ability to deliver timely and excellent care to our patients. And finally, repealing and replacing ObamaCare with a reasonable healthcare reform is the obvious one.