Healthcare Reform Could Impact Specialty Care

As the 24th annual meeting of the North American Spine Society (NASS) convened this week in San Francisco, Calif., treatment and technology were, of course, the primary topics of presentations and discussions. But, given the current political climate, as physicians and medical technology company representatives gather, talk of healthcare reform is inevitable.

A good portion of the event’s Thursday agenda is dedicated to an examination of the healthcare reform proposals currently being hashed out in Washington, D.C., and what the potential impact could be for spine physicians, patients and the medical technology firms that compete in this sector.

Raj D. Rao, M.D., advocacy chair for NASS and professor and director of spine surgery at the Medical College of Wisconsin in Milwaukee, sat down with Orthopedic Design & Technology to discuss how current legislative proposals could change the playing field.

“Overall, we have no argument that some sort of reform is required,” Rao said. “But many questions remain about what form the reform will take and what the end results will be.”

For example, there are aspects of the individual pieces of proposed legislation passed by the U.S. House of Representatives and the Senate’s Finance Committee, with which spine physicians take exception.

“President Obama’s push for reform is three-pronged. He wants to reduce costs to families, to businesses and to the federal government,” Rao explained. “He wants to reduce the number of uninsured patients and provide an insurance system that’s stable and secure. These are good goals, and, overall, we have no arguments that some sort of reform is necessary. But we have some concerns on the course chosen in the implementation of these goals.”

One of the concerns Rao cited was a provision in the House that would reduce payments for specialty physicians-such as spine surgeons-and increase payments to primary care physicians.

“We [spine physicians] are better suited to treat patients with spinal disorders,” he argued. “In the long term, spine specialists will provide more cost effective care for patients with spine disorders.”

Rao said that in the rush to reduce cost, there is a perception by lawmakers and perhaps the general public that too many procedures are being done.

“The question that needs to be answered is how do we continue to improve quality while still reducing cost,” he said, arguing that it would make sense to make payment adjustments only after significant research has been done. “Reductions in payments to specialists can affect our ability to provide appropriate care for our patients, and potentially exacerbate workforce shortages over a longer term.”

Legislation in both the House and Senate would create research centers to examine the efficacy of various healthcare services, devices, treatments and procedures. None of the bills require the research be used to force health providers to adopt new procedures or policies to cut costs, which is an administration priority. Obama provided $1.1 billion in the stimulus act to fund so-called comparative effectiveness research (CER).

Rao said the goal is laudable, but that comparative effectiveness research would be carried out by the government, which may not have the expertise to accurately evaluate what they’re charged to monitor and review.

“We feel very strongly that as CER should be carried out by people who understand the procedures and the technology,” he said. “There needs to be input from specialists.”

He also noted that part of the Senate Finance Committee’s legislation calls for a Medicare advisory committee to be created to determine how Medicare payments are made and to make changes where they see fit. The committee would be independent of Congress without and Congressional oversight.

“The Medicare advisory commission the senate proposes has no congressional oversight and should have appropriate specialist physician representation.” Rao said NASS has met with committee staff members in the House and the Senate to inform them of the society’s concerns.

“Will continue to reach out and try to educate them,” he said. “We’re hopeful that they will make some adjustments.” If some of the society’s requested changes aren’t made, there could be serious long-term impact on our ability to take care of patients with spinal disorders. “For example, one long-term effect would be fewer graduates from medical schools and fewer physicians pursuing specialties, which, in turn, will affect the innovative, high-quality care that the United States has been a leader in for many decades.”