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 is the number one thing spine practices should look for in electronic medical records?
Please send responses to Laura Miller at
by Thursday, Nov. 22, at 5 p.m. CST.
Stephen Hochschuler, MD, Chairman, Texas Back Institute Holding Corp.: I would suggest the first change in the healthcare legislation be recalling Obamacare. It's too expensive with too much pork barrel rolled in. I would also suggesting revamping medical malpractice insurance to better represent the patient and limited but fair legal reward.
Hooman Melamed, MD, Orthopedic Spine Surgeon, Marina Del Rey (Calif.) Hospital: If all hospitals and physicians are getting reimbursed less, then the insurance companies should as a result become less profitable. There must be a cap on the steady rise of co-pays, deductibles and premiums. It is important for there to be policing and auditing of insurance companies who are more frequently denying procedures, especially spine treatments, for patients by using the term "not medically necessary."
Unfortunately, Medicare and Medi-Cal fraud is much too prevalent and it must be more thoroughly investigated. In addition, there must tort reform on medical liability. Millions of dollars are wasted every year by doctors practicing defensive medicine.
Thomas Schuler, MD, President and Founder, Virginia Spine Institute, Reston: Now that the election is over and Barack Obama won, ObamaCare is a reality. The confusion for business and states was whether they would repeal or change ObamaCare; now it's here to stay. Everyone needs to come to grips with what this means. A fundamental paradigm shift is occurring in U.S. healthcare. The government is asking physicians to do what is best for society not what is best for the individual patient! Currently, the law does not clearly define all obligations. Much uncertainty exists. Physicians have ambiguity on how it will impact their practices.
The biggest issue is that much of the law requirements haven't been developed. The insurance exchanges have not been set up and in 2014 people are supposed to be buying insurance on healthcare information exchanges that don't exist yet. The law has encouraged consolidation of the insurance industry and its products. Fewer companies are providing fewer products which is heading towards a monopoly. Ultimately one to three payors will cover the U.S. insurance market with very limited products. This will make rationing of care much easier. ObamaCare will fundamentally change the way care is delivered in this country. The Independent Payment Advisory Board will limit the care to individuals covered by Medicare and Medicaid. These insurance monopolies will adapt these policies to benefit their bottom line. Pursuing socialized healthcare even with private insurance companies involved, less people will decide what is paid for and how much is paid for procedures. This will produce significant rationing of care by companies as well as physicians, because the physicians won't get paid for their services.
Democrats focus on large government, big corporations and centralized power. The Republicans focus on state's rights, individual rights and small business. Since the Democrats won, and that has been Obama's ideology and agenda, we can only expect that to be advanced at extreme rates. This is detrimental to the economy and to physicians.
Theoretically, ObamaCare was designed to insure more Americans for less money, yet in fact it will cost more money. Our government will steal from the Medicare program and further burden the Medicaid program by adding 10 million additional people. The end result is increased expenditures, increased deficit spending and deterioration of America as a power.
Our greatest threat to national security and our democratic way of life is our national debt. The results of the election are going to worsen that condition, as demonstrated by the track record of Obama over the past four years. Nothing he has done or has promised to do will reverse that course, unless there is a drastic change in his practice and ideology, to date he has failed to demonstrate, any interest or willingness to change.
Jeffrey Wang, MD, UCLA Spine Center: The one change I would suggest is that legal and tort reform is critical when trying to change healthcare policies. In order to change the healthcare system and use our resources more efficiently, appropriate changes in litigation reform must accompany these changes.
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