Q: What kind of relationships does the AAOS have in Washington?
Dr. Peter Mandell: We have a pretty healthy working relationship with Congress and the regulatory agencies. When thinking about healthcare for this country, our goal is what’s best for patients.
Q: Is there any chance that the sustainable growth rate (SGR) could be finally eliminated so that physicians would no longer be threatened with massive cuts in Medicare reimbursements every year?
PM: Elimination of the SGR has been included in one of the House’s draft reform bills. However, as currently written, it is not a complete fix. The bill would erase the "debt" that has built up year after year, as Congress agreed to postpone planned pay cuts. That is, it would wipe the slate clean. However, the bill would then start the process all over again, using a new formula based on the gross domestic product. This formula wouldn’t take into account the tremendous increase in healthcare services that would be needed as the population ages.
Q: What is the current state of health reform legislation in Congress?
PM: Coming up with a working reform plan is very tough, demanding work. In the House, three reform bills were approved by the Ways and Means, Energy and Commerce, and Education and Labor committees. The Democratic leadership in the House has been melding these three bills into one bill. This measure, called the tri-committee bill, is already being circulated in draft form. In the Senate, the Health, Education, Labor and Pensions Committee has approved a bill, but the Senate Finance Committee has postponed its decisions until September, at the earliest. The Senate bills would eventually be merged into one bill and then both houses of Congress would vote on their respective bills sometime in the fall.
Q: What are some big issues in the health reform debate and what does the AAOS say about them?
PM: One big issue is the possible creation of a single-payor system, in which one entity, the federal government, would pay all healthcare expenses. None of the bills are proposing this, but that doesn’t stop a lot of people from talking about it. It scares a many people to death, notably the health insurers. There is a lack of unanimity within the AAOS Fellowship over single-payor, but most members are against it and our official position opposes single-payor.
Many people also fear the possibility of rationing, even though the drafters of the current health reform bills say they are not calling for that. Of course, we already have rationing. It’s financial rationing: those who do not have insurance or have poor coverage cannot get all the care they need. A single-payor system, on the other hand, imposes waiting-in-line rationing. People would have insurance coverage but they still might not be able to get the care they need. Furthermore, if reforms reduce what people have to pay for healthcare, they may overuse the system. People might make appointments all the time for relatively trivial concerns and ask for tests they don’t really need.
Q: What concerns does the AAOS have about the health reform legislation as it stands now?
PM: We have no idea what the final bill would look like, but already we have some concerns. The AAOS believes that everyone should receive healthcare, including specialty care. Providing coverage, however, is not the same thing as providing treatment. In the combined House bill, as it now stands, we have concerns about a proposed committee to oversee Medicare that would be called the Independent Medicare Advisory Council (IMAC). Like the current Medicare Payment Advisory Commission, IMAC would make decisions about Medicare policy, but unlike MedPAC, IMAC wouldn’t need Congress’ approval. It would be a super MedPAC. The AAOS believes Congress needs to be involved in the decisions.
Q: Would any of the healthcare reform bills do away with physician-owned hospitals?
PM: As a matter of fact, the tri-committee bill in the House would prevent construction of new physician-owned hospitals and even prevent existing facilities from expanding. The AAOS is opposed to this.
Q: How do you think health reform will play out?
PM: There could very well be something that passes that would be called "health reform" but wouldn’t be very exciting or effective. On the other hand, they could pass a bill that could do a lot to improve the system. My personal opinion is that if they don’t overreach they can make some real progress in improving our healthcare system.
Q: What is the likelihood that Congress will pass the AAOS-supported Access to America’s Orthopaedic Services Act (S. 1548)?
PM: If I had a crystal ball, I would be able to tell you. But I wouldn’t be surprised if at least parts of it were incorporated into the final health reform bill. Just having Congress’s attention focused on healthcare might be very helpful to its ultimate passage.
Q: It has been stated that S. 1548 would not cost the government anything — that it would be "revenue-neutral." How could that be?
PM: It would redirect money from existing programs. There are health conditions that are higher-profile than orthopedic conditions, such as heart disease and cancer. In comparison to those conditions, not much attention has been directed to orthopedic diseases, even though we know that they are very widespread. Research studies show that one in four Americans have a musculoskeletal problem that requires treatment. Musculoskeletal conditions are very important to Americans and studying them should receive adequate resources.
Q: What would the orthopedic bill mean for the average practicing orthopedic surgeon?
PM: There are a variety of provisions in the bill. For instance, it would make sure that women and the elderly get a lot more information on how to deal with orthopedic problems. For example, if young women can be persuaded to drink milk, exercise and eat right, they can build that extra bone mass needed for later in life, when osteoporosis occurs.
The bill would also better coordinate trauma care. A lot of trauma is musculoskeletal. And the bill would call for a study to ascertain the need for the orthopedic healthcare workforce and recommend what can be done to train more orthopedic residents. Currently, the number of graduate medical education positions funded by Medicare has been frozen, even as healthcare needs are advancing.
Learn more about the AAOS at www.aaos.org.
