Ten spine surgeons talk about what they expect from Donald Trump over the next four years and how their practices are preparing for the future.
Scott Blumenthal, MD, Texas Back Institute (Plano): He has promised to repeal Obamacare and has the congress to get it done. My question is what will it be replaced with. What happens to the millions on the exchanges? Will they be uninsured? Will there be a public option? My opinion is that we need to reform and more tightly regulate the private insurers. And how soon will we build "the wall!"
Stephen Hochschuler, MD, Texas Back Institute (Plano): Personally, I believe change in every level was and is needed. Value-based medicine is here to stay!! Obamacare, despite promises, cost the average American a huge increase in deductibles and one was not able in most cases to keep their Doctor or Health Plan. Delivery of spine will be influenced by MIS, outpatient surgery, global fees and episodes of care; direct patient marketing, coalition of various groups locally, regionally, nationally and internationally; the growth and importance of IT; mergers/affiliations aggregations of pharma/implant companies/insurance companies/spine surgeons/hospital systems; growth of consults, rehab, pre-hab, coalition through telemedicine, etc..
John Dietz, MD, OrthoIndy (Indianapolis): I watched Tuesday evening’s election coverage stunned — flabbergasted. Just like everyone else in our great country. Now I'm busy trying to understand what it means for healthcare. I've talked to surgeons who are deeply saddened by our country's decision to elect Mr. Trump. Others are frightened, even ones who supported the Republican nominee. Still others in our group are elated beyond belief, feeling the Affordable Care Act would be immediately repealed and our economy saved. I say the same thing to all: Take a deep breath. We live in the greatest country this earth has ever known. The political system that created this country has taken its course. The left and right will still be there tomorrow as they were yesterday. Now we need to get to work.
One possibility is that Mr. Trump rolls up his sleeves, calls the far right and the left into the room and says "Now we get to work." If all voices are in the room. Personally I don’t want to see another 2008 to 2010 where Mr. Obama's team acted unilaterally, alienating the center ever since. If Mr. Trump pushes too hard in one direction there may be a backlash and the pendulum will swing back to the detriment of the country. If Mr. Trump sets the stage to solve problems then the naysayers in both parties will be too busy counting their accomplishments to gridlock the government.
What happens to healthcare? First, filling the Supreme Court vacant seat is an immediate and lasting accomplishment. That alone is worth all the misery of the last four months. I am encouraged and I think the country will be well served.
Healthcare needs competition, not consolidation. Competition improves quality and reduces costs. Applying that maxim to the Affordable Care Act would be a great next step. The anti-competitive portions of the bill could be eliminated immediately including the provision which bans physicians from any owning a portion of a hospital. Follow the data and reward programs that improve quality at a lower cost. After that, inject competition and transparency into every healthcare experience and we will get more work done for fewer dollars. That’s the goal isn’t it? Competition is key.
Regulatory agencies which operate largely outside public oversight have become a bludgeon beating our economy — and specifically the healthcare economy — to death. Regulation without demonstrated improvement of outcomes drags down every patient and every physician. The regulatory burden needs to be reduced. Equally important is to build checks and balances, which control the regulators and take government agencies from the CMS, to the FBI and the IRS, out of the business of achieving political goals. People cynically call these regulatory agencies the "fourth arm of government." That needs to change. Congress and the White House can work together to make a better system.
Robert Masson, MD, NeuroSpine Institute (Orlando): The election of 2016 has finished and the American people have very clearly spoken. I personally supported the beginning of the ACA, not because I agreed with its final product but because I was grateful that people were talking, debating and imagining a post-modern healthcare system.
I am clear that this election suggests that the American people want a different Washington and a better healthcare system. I remain optimistic that this seismic election will continue to change our healthcare system forward and my particular expectation is holding health insurance companies accountable. I also believe that the industry supporting technology in healthcare needs to be proactive and innovative again. Careerism in the major companies has stagnated our Innovative capacity.
Relative to our practice we will continue to focus on optimization of spine health and solutions. The changing landscape has demanded that we change our processes and I expect that to continue.
Kern Singh, MD, Midwest Orthopaedics at Rush (Chicago): I think the next four years may be even more interesting than the last eight. With a Republican President and Congress we may actually see a repeal of the Affordable Care Act. Unquestionably, President Trump campaigned on that very premise. For the average patient, hopefully that means lower deductibles and premiums. For me as a physician, it really will depend upon what the ACA is replaced with. My sense is that the onerous requirements of medical records and documentation will still be there but that the health exchanges will be removed. This may open up a window for patients who are currently working and receiving employer-based health insurance to get access to the spine surgery they may need and require.
John Finkenberg, MD, Alvarado Orthopedic Medical Group/Helix Orthopedics & Sports Medicine (San Diego): It will be important for the Spine Care Specialists to pay very close attention to our current MACRA and MIPS requirements as these rules that are currently in place and will not be easily repealed or replaced in the next two to three years. The GOP Congress and administrative branches will make modifications to the current rules more possible. CMS has already made modifications that will allow more options for everything from negative adjustment to reimbursement. The checks and balances built into our political system will still make legislative change slow as major healthcare legislators are not viewing our healthcare issues the same way as our incoming president.
It will be important for the GOP to look carefully at which portions of the current law should be modified first as our ultimate goal is to benefit all members of our society and not just the medical sector. The eyes of the world will be on us at this very important time in history and it will be our obligation as healthcare professionals to usher in a system that provides the highest quality of care at an affordable cost. I am confident that we are up to the task and can make the necessary adjustments to remain the premiere healthcare system in the world.
Sheeraz Quresh, MD, Mount Sinai Medical Center (New York): I am hopeful that this election's results will mean that the Cadillac tax will be repealed so that employers can continue to offer good coverage to their employees without paying a heavy penalty. I am also hopeful that we can find a way to significantly improve Obamacare while maintaining the positives such as providing coverage to those who weren't covered otherwise.
Mick Perez-Cruet, MD, Michigan Head & Spine Institute (Southfield): I think the next four years under Donald Trump will see improvements in healthcare management and advancement of innovation. Allowing insurance companies to compete across state lines should help to bring the cost of healthcare premiums down. Perhaps he will tackle the liability issues that add to the cost of healthcare delivery. However quality healthcare will continue to be costly but worth it. After all, your health is your most valuable asset.
William Tally, MD, Athens (Ga.) Orthopedic Clinic: I think anyone who makes any predictions about changes to the trajectory of healthcare is guessing. Undoing Obamacare will be difficult on the ground level. Changes can be made from a legislative perspective but so many of the onerous items in that bill are already implemented and will be difficult to change. The limiting factor will be Trump's ability or inability to work with congress. I think he's a lot like 'spacemount'. It's a heck of a roll coaster, you just don't know where it's going.
Richard Kube, MD, Prairie Spine & Pain Institute (Peoria, Ill.): Everything is going to be speculative. We are pretty sure what would have probably happened had Hillary been the president elect; it would have been a continuation of existing policies. With Donald Trump, things are somewhat speculative because he doesn't have a political record. From a business standpoint and what he indicated in speeches, he is for decreasing regulations. He has no respect for Obamacare and now he has the house and Senate behind him. We will see some degree of repeal of Obamacare, and without the administrative regulation, we could see a positive impact on our practice.
Decreased regulation gives us more time to spend with patients instead of paperwork or talking to people who have nothing to do with the care process. From our business standpoint, insurance rate skyrocketed since Obamacare; anything that puts a check on that will help our bottom lines as well. In our practice, insurance rates went up 12.5 percent; even a small practice that's five figures. These are big things that certainly, if you have spent the last several years planning for that, it impacts hiring, strategic planning and next growth component, from our standpoint we feel more optimistic that it might not go up in as accelerated way. Those are some pretty quick initial things that will probably happen. We are all sick of regulations. I am optimistic about the future; no matter what happens there is some opportunity that lays there. As someone who has been frustrated by increased paperwork, regulations and items that require work and attention without a real impact on patient care and experience, anything shifting from that is a pleasant thought.