Five spine surgeons discuss opportunities for clinicians under President Trump.
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.
Next week's question: What are some disadvantages that spine surgeons may face under the new administration?
Please send responses to Anuja Vaidya at email@example.com by Wednesday, March 1, at 5 p.m. CST.
Question: What are some of the biggest opportunities for spine surgeons under the new administration?
Ian A. Madom, MD. Spine Surgeon at Ortho Rhode Island (Providence): As with any new administration, there are opportunities to improve the health of Americans, and the health of our system that delivers care. Yet one month into the new administration, it seems that these opportunities will be rare given the highly partisan environment that only seems to be more divided by the day.
Removing the ACA without a fully-developed plan would be a mistake, and only create greater uncertainty for our patients and the market. The replacement for the ACA is beginning to emerge, and this is where we as spine surgeons can have the greatest impact. No program is ever a complete success or failure. The best approach is thoughtful, distinguishing between what is working and what is not. Our interests are best served by helping lawmakers understand these differences.
Kern Singh, MD. Co-Director of Minimally Invasive Spine Institute at Midwest Orthopaedics at Rush (Chicago): I am hopeful that, by deregulating the health insurance marketplace, the new administration will transfer power from large administrative networks back to the physicians. In turn, I expect to see a reduction of the bureaucratic oversight that hinders the full scope of our practices. I think these changes will really give independent practices a better chance of survival and allow all spine surgeons to practice in a manner they see more fit.
Richard Kube, MD. Founder and CEO of Prairie Spine & Pain Institute (Peoria, Ill.): Certainly, there is a bit of uncertainty with any administrative change. However, if the administration pushes the health savings account agenda, I believe there will be opportunity for those independent groups able to provide bundled services. With increasing deductibles, policy changes like those above will create market forces within medicine that bear some similarities to the rest of the world. The consumers (patients) will have more direct interaction with payment for services, and that will motivate them to shop for value. Ambulatory surgical facilities are typically streamlined, which facilitates their ability to compete on value.
Understanding one's costs and having an ability to become efficient and create a package for patients reflecting those objectives will create a niche that will be increasingly desired by the general public, and the self-insured businesses who are seeing healthcare costs continue to rise. We have been working into that niche for the past couple of years and we are seeing an increased interest from a variety of parties entering that space.
Vladimir Sinkov, MD. Spine Surgeon at New Hampshire Orthopaedic Center (Nashua): While it is difficult to tell exactly what new policies will be enacted by the new administration, I am hopeful that they will stay true to their campaign promises of repealing and replacing Obamacare. I am hoping that the new administration will realize that it is difficult for physicians to provide the same level of excellent care to our patients while they lower the reimbursements for our services every year. Even though the sustainable growth rate was repealed, most CPT codes were devalued this year, at least in the fields of orthopedic and spine surgery.
I am hopeful that something will be done to address the medical liability situation, which currently does not protect our patients or providers. I am hopeful that the burden of new rules and regulations that turn the physicians into bureaucrats will be eased, such as EMR requirements, MACRA, etcetera. Such regulations have not been shown to improve care or reduce costs in the field of spine surgery.
In summary, I am hopeful that the new administration will simply figure out how to "get out of our way" — to quote John Galt — and let us practice medicine and help our patients live longer, happier, more productive lives to the best of our ability and knowledge. That is the biggest opportunity I can hope for as a spine surgeon.
Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: I think there are two things that we can be sure of: change and uncertainty. With regards to what are opportunities for us — it is very early to call. My hope is that the new secretary of HHS, Dr. Price, will be a good listener and enact reforms that can help our patients and keep doctors practicing medicine. It seems that the overall temperature is that of repeal, and I think when the ACA is fully repealed, we will get a better idea of the ground rules. But what I think, what I hope, is that the insurance companies will be held more responsible for authorization and payment for services. I also see the Independent Payment Advisory Board becoming a fossil and being thrown out completely — finally.