In the wake of last week's Presidential election, many people are debating where the healthcare system in this country is headed. Barack Obama's re-election ensures the Patient Protection and Affordable Care Act will move forward, with many different voices contributing to the implementation process. Here, Kenneth K. Hansraj, MD, chief of spine surgery, New York Spine Surgery & Rehabilitation Medicine, discusses the three responsibilities Americans have as they consider how to move healthcare — and spine care — forward. 1. Responsibility to the patient. "I really believe that all Americans should have access to our excellent healthcare system," says Dr. Hansraj. "One of the things we do best in the world is to provide healthcare and it's not right that millions of Americans don't have access to healthcare. We have a responsibility to these people."
Spinal problems are a significant concern for people worldwide, as four of five people will experience spine and back pain at some point in their lives. Adding more people to the insured ranks will likely increase the number and type of people seeking spine care today.
"Spine specialists will be incredibly busy and we'll need to rethink how we do business," says Dr. Hansraj. "How will we best serve our patients? New algorithms will be needed. We will need more conservative care rendered by physical medicine and rehabilitation specialists."
2. Responsibility to spine surgeons and specialists. "The PPACA will bring 42 million Americans into the insurance system and provide certain opportunities and challenges for spine surgeons," says Dr. Hansraj. "Due to the sheer bulk of patients, the definition of 'spine surgeon' will change. We are super specialists, but right now we see a lot of conservative cases. In the future, we will become predominantly operative spine surgeons."
One of the biggest challenges for all physicians and specialists will be the reimbursement rates from the government payor within the new system. Medicaid rates are currently unsustainable for spine surgeons, who in many situations would prefer to provide charity care rather than bill Medicaid for services rendered.
"If the payment schedules come out at or about the rate of Medicaid, it will be difficult for spine surgeons to see these patients," says Dr. Hansraj. "It costs more to bill Medicaid than to provide the charity care. There are assessments that show Medicaid rates at best cover 72 percent of hospitals costs of doing business. Now you are looking at bringing in 42 million clients at a cost-losing status. It remains to be seen how spine surgeons will handle that."
Another big issue for spine surgeons is tort reform. The cost of carrying malpractice insurance is increasing and the legislators in most states haven't made a serious effort to reform these laws. Americans have a responsibility to ensure their surgeons and specialists are compensated fairly and able to keep their practice running into the future.
3. Responsibility to ourselves. "We as Americans have a responsibility to ourselves," says Dr. Hansraj. "I believe that Americans are going to have to be more educated about themselves, especially their bodies. They should know how their bodies function and take steps to make sure they are living healthy lives."
Recent statistics show that the cost for spine care in the United States is $100 billion per year. People can help trim those costs by eating right, exercising, meditating and being careful with their bodies.
"For the last four years, I have been working on a book project called 'Keys to an Amazing Life: Secrets of the Cervical Spine'," says Dr. Hansraj. "I get so many patients coming in to me wanting the latest titanium device that will do the surgery with a positive result. However, I think there are many things you have in your hands daily — the way you sit, sleep, breathe and think — that can make a huge impact on many lives."
Dr. Hansraj hopes that as people become more aware of the control they have over their own health, they will take responsibility for it. "Most people spend a lot of time servicing their cars — they know all about the carburetors and keeping a clean cabin — but they don't spend an hour per week exercising, eating right or sleeping properly," he says. "When I work with clients, they are very responsive and thankful. I think that Americans are receptive to new information driving their bodies and their lives."
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