At the North American Spine Society Annual Meeting last week, a group of spine surgeons led by Alan S. Hilibrand, MD, discussed healthcare reform and what spine surgeons need to know for successfully navigating the coming changes.
Dr. Hilibrand began the presentation by describing the healthcare reform and detailing a timeline for implementation through 2018 and beyond. He touched on the positive aspects of reform, including consumer protections:
• Ended pre-existing conditions for kids
• Ended lifetime limits on coverage
• Began elimination of annual limits
• Set up external review of denied claims
Healthcare providers are now faced with value-based purchasing programs, incentives to care providers for accountable care organizations and incentives to physicians and practices to establish electronic health records as a result of reform. Additionally, in 2015 the employer mandate goes into effect requiring employers with 50 or more employees to offer health insurance or pay a penalty. The individual mandate requires every person to obtain minimal essential coverage if not through the employers. The penalties are small for the first year, but grow over the next few years.
Another change impacting spine surgeons are the PQRS measures.
"By the end of this year you should try to comply with some of these measures," said Dr. Hilibrand. To avoid the penalty, surgeons are required to report on one measure. To receive a bonus, physicians must report on three quality measures. The PQRS quality measures are available on the Medicare website and include measuring for osteoporosis and arthritis and tracking patients that smoke.
David Wong, MD, past president of the North American Spine Society and member of the NASS Washington Committee discussed accountable care organizations. "As part of the ACA, innovative payment models was part of the key provisions," said Dr. Wong.
Hospitals are consolidating outpatient services for the ACOs and employ primary care and specialty physicians to include the physicians. Insurance companies are also looking for providers who can become an ACO. Specialists can align with ACOs, and currently they are able to align with more than one.
"You have to be very careful if you get involved in the ACOs because you have to figure out what your base payment is based on historical data, so you have to have extremely accurate data," Dr. Wong said. "If you don't have things or miss things, you end up with a lower payment than you should have gotten, then you are going to be on the hook for the losses."
Ray Baker, MD, discussed how PPACA will impact non-operative spine care. "There has been a lot of changes and shifting in the healthcare and hospital systems consolidating and a lot of insurance consolidations and changes as they prepare for upcoming developments. A lot of these things have not rocked your world yet. You look at the things and really your day to day practice hasn't changed all that much."
However, Dr. Baker did discuss three changes he sees coming that will have a big impact on a physician's day-to-day practice in the near future:
• State decisions of Medicaid expansions
• Health insurance exchanges
• Accountable payment models
"The value train is unlikely to be derailed and it has picked up significant speed in the past three years," he said. Later in the presentation he added, "On the pricing front, we are already seeing a roll out of a number of policies and shifts that are going to steer patients to specialty centers or low cost provider. They tout quality but really in the end quality is now a given. It's the price for administering and as predicted the insurers are focusing more on the cost variable in the equation."
He has seen some patients becoming more cost-conscious and choosing providers based more on price than in the past. People are also being more frugal with their healthcare dollars and choosing against elective procedures more often. His discussion also touched on:
• Consolidation in the market
• Insurers purchasing physician groups
• Non-physician practitioners expanding their scope of care
• Physician employment
"Despite these dramatic changes in healthcare I do still see a bright future for those who are able and confident enough to think completely differently and bold enough to act," said Dr. Baker.
Finally, John Finkenberg, MD, chair of the NASS Advocacy Council, discussed quality measures, the Independent Payment Advisory Board, NASS Advocacy Issues and how advocacy influences legislative issues. The most important legislative issues NASS is currently focused on include:
• Permanently repealing the sustainable growth rate
• Repealing IPAB
• Enacting meaningful medical liability reform
• Quality improvement and value-based payment reform
"Our legislative victories have been many. We've done more than 150 visits to the Hill and talked to legislators," said Dr. Finkenberg. "We fly in twice every year to meet with them and actually have several come to us at one site. We've gotten them to have bipartisan agreement with the Medicare reimbursement repeal, on repealing IPAB and we've been asked by both the Energy and Commerce as well as the House Ways and Means committee to give them strong input on what we want to see changed with Medicare reimbursement and we have given those to them."
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A New Spine Surgery Technique to Minimize Blood Loss in Spinal Deformity Correction: Q&A With Dr. Fred Sweet