Spine surgeons discuss the merits and demerits of the Patient Protection and Affordable Care Act signed into law five years ago.
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: Which clinical innovations in spine excite you the most?
Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, April 8, at 5 p.m. CST.
Question: Five years into the PPACA, do you think that the U.S. healthcare industry is better off or not?
Thomas Errico, MD, Chief, Spine Division, NYU Langone Medical Center, New York: Well after all the shouting and screaming finally dies down, in its simplest form anything that increases the amount of insured lives for the public will benefit the overall healthcare industry provided they watch their true income/expense balance sheet closely. It is very easy for hospitals to look at their charges and complain that they aren't getting paid enough. It is relatively easy for hospitals to look at their overall profitability at the end of the year. The real winners will be those that can micromanage all their different service lines and squeeze out the fat of their budgets and become more cost effective and analyze this on a quarterly basis. Constantly searching to get more bang for their buck and hence the government's and third payer's buck is critical.
The vendors are in the same situation. They can either moan about the pricing they used to get or they can realize we are all in this together and if they don't come up with more cost effective solutions, one of their competitors will and they will be outside left looking in. When they spend research money it can't only be to come up with a more profitable product line but one that will be attractive to the hospital in their attempts to balance their budgets.
Christian G. Zimmerman, MD, MBA, Saint Alphonsus Medical Group, SAHS Neuroscience Institute: The distractions of a busy livelihood most likely have clouded all the Medicare reductions that occurred almost immediately following the passage of this unfunded legislation. Since 2009, the further unraveling of this additional entitlement program has effected reimbursements to hospitals and providers alike. The tax implications and soon to be selectively imposed penalties are profound for big and small business alike. Recent moves by America's colleges to drop health coverage is clearly another move to shift more individuals into these marginally narrow covered plans.
The spinal community is under more scrutiny from traditional insurers to cut costs with either less procedural reimbursement by collation of operations or simply denial of payments based on disqualifying measures. Interestingly, these are only one of many changes scheduled for implementation by 2017.
Richard Kube, MD, Prairie Spine & Pain Institute, Peoria, Ill.: I do not believe that the healthcare system has improved. There are multiple added layers of accounting to the government and there have been few added benefits. While there are individuals who obtained new insurance, there are others who have lost insurance thus questioning whether there was a net gain. Premiums have sky rocketed (up over 50 percent for our office in last three years) contrary to the alleged savings we were all going to see.
We have a local business with almost 1,200 employees that saw its entire profit margin disappear; they intend to close their doors permanently. Where are those folks going to work, much less obtain health coverage? It is inherently counterintuitive to think that an entity — the U.S. Government — that runs solely because it is allowed to deficit spend could somehow financially correct the healthcare system. The only way to drive value in our healthcare system is to make the consumer have some skin in the game. PPACA strives to do the opposite. Anyone who thinks this was a good idea should spend more time at the VA or the Post Office.
Kern Singh, MD, Co-Director, Minimally Invasive Spine Institute, Rush University Medical Center, Chicago: Honestly, there is no difference. Clearly insurance premiums have gone up for the individual consumer and yet physician reimbursement remains the same. That means total costs in the healthcare sector have increased. How can that be good for us?