Here five spine surgeons discuss the biggest challenges of roll out of the Patient Protection and Affordable Care Act for spine surgeons and their practices.
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 are some of the biggest opportunities for growth in the spine industry in the coming year?
Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, Feb. 5, at 5 p.m. CST.
Question: What, in your opinion, are the most challenging aspects of the Patient Protection and Affordable Care Act roll out for spine practices?
Fred Naraghi, MD, Comprehensive Spine Center, San Francisco: For private practice spine surgeons like me, there are two main issues — increased cost to the practice and diminished reimbursements. As the new law rolls out there are many aspects of it that are still uncertain. For example, the government has increased the threat of fines for breach of security of protected patient data. We have had to pay for a number of additional services such as encryption of the computers, etc. The new law clearly has many issues that would need to be addressed and fixed.
Paul Slosar, MD, President, SpineCare Medical Group, Daly City, Calif.: The unpredictable nature of the rollout with special exemptions coming late has thrown the insurance industry into difficulties. This in turn leads to problems for us and our patients down the line.
Specialists cannot accurately assess the impact of this law on their practices and revenue streams. We cannot take preemptive actions but can only react to losses as they occur. The most serious concern for spine surgeons is probably something that is in their "blind-spot" which is called "de-selection." Insurance companies have already formed narrow-networks and many top-tier hospitals and surgeons have been "de-selected" without any warning. The ACA is a catalyst driving the formation of narrow networks and will accelerate the trend toward bundled payments.
Alpesh Patel, MD, Associate Professor in Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago: With the rise of insurance coverage, we will see a growth in demand for spine care. This demand, especially with certain payers, will be coupled with low reimbursements. The combination of the two will drive surgical spine practices to make difficult decisions over who they will and won't see, with incentives to care for young, healthy and well-insured patients. In the academic university setting we anticipate a continued shift of the sick and poorly insured to tertiary centers. Over the years, access to care will therefore be limited both in private and tertiary centers.
We have already seen the effects of the healthcare legislation. Between public reporting of patient outcomes and declining payments, spine practices are already adapting to the pressure for low cost, high quality spine care. For spine surgeons this means providing evidence-based care and actively working with their hospitals to reduce complications and costs of care.
Jeffrey Wang, MD, Chief, Orthopedic Spine Service, Co-Director, USC Spine Center, Keck Medical Center of USC, Los Angeles: I think the largest challenge is for spine surgeons and spine practice groups to learn the new system, requirements and what the consequences are for not meeting certain guidelines.
This is an educational issue where surgeons need to spend the time to understand the process and perhaps more importantly, how their institution or individual group practice will continue in the new environment.
Sheeraz Qureshi, MD, Orthopedic Spine Surgeon, Icahn School of Medicine at Mount Sinai, New York: The most challenging aspect of the Patient Protection and Affordable Care Act for spine practices is being able to provide patients with appropriate care without an understanding of what the patients' financial responsibility will be.
It is unclear to most physicians what type of coverage patients will get for standard diagnostic tests and accepted treatment options. Further, it is more unclear to the patient. In some cases, patients may be spending more for worse coverage. In other cases, while patients may be paying less, they are surprised to find out how lacking their coverage is.
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