Healthcare reform: Some progress, but a long way to go

More than 500 fellows attending the Symposium and Open Forum on Healthcare Reform heard Joseph D. Zuckerman, MD, 2009-2010 president; John J. Callaghan, MD, first vice president; Daniel J. Berry, MD, second vice president; Peter J. Mandell, MD, chair of the Council on Advocacy; and David J. Lovett, JD, office of government relations, outline the steps taken by the American Association of Orthopaedic Surgeons aimed at affecting the debate over healthcare reform. Fellows also had the opportunity to ask questions and express their opinions on measures currently being considered by Congress.

In summarizing the advocacy efforts of AAOS made during the past year, Dr. Zuckerman reviewed the depth and breadth of the actions taken to build coalitions, represent and respond to member concerns, and encourage grassroots involvement by members in the debate. Communication efforts, for example, included 22 healthcare reform updates, 12 calls to action, and a town hall teleconference on the issue.

In addition, the AAOS launched several new initiatives and campaigns to advocate specific positions in Congress and in the general public.

Dr. Zuckerman acknowledged that although AAOS efforts and strategy on healthcare reform have been sound and effective, there is room for improvement.

“I think that one place we could do a better job is in educating our patients about what healthcare reform will mean for their ability to access care,” he said.

“Singling out specialists”
In his review of the principles of healthcare reform, Dr. Mandell noted that the administration seemed to single out specialists, such as orthopaedic surgeons. He reminded the audience of President Obama’s misguided remarks on reimbursement for amputations and noted that not a single surgeon had been invited to any of the meetings held at the White House.

Dr. Mandell also pointed out that the AAOS has a number of concerns about issues not addressed in the current drafts of healthcare reform bills. He reviewed the results of an online survey conducted by the Alliance for Specialty Care, which attempted to identify what would happen if the projected 21.2 percent cut in Medicare reimbursement actually went into effect as was scheduled for April 1. The results of the survey showed the following:

  • One third of respondents would continue to accept Medicare patients.
  • One third of respondents would not accept new Medicare patients, but would continue to serve their current Medicare patients.
  • One third of respondents would retire or opt out of the system.

Such results are problematic, said Dr. Zuckerman, because they can be interpreted to mean that at least a third of physicians think the payment reduction is acceptable. Until access becomes problematic and patients begin to complain, he pointed out, Congress is unlikely to enact a permanent fix to the sustainable growth rate (SGR) formula.

When asked if Congress would potentially allow the cuts to go into effect, Dr. Mandell responded, “I don’t believe they will allow the cut to go into effect, but I think they will just pass another temporary extension.” (See “Congress delays cuts again,” below.)

In his remarks, Dr. Callaghan reviewed several scenarios for passage of a healthcare reform bill. Dr. Berry followed by reviewing the regulatory issues—such as health information technology, pay for performance, and the Physician Quality Reporting Initiative—that will also have an impact on the delivery of health care.

From taxes to access
During the question-and-answer session that followed the presentations, several members proposed their own healthcare reform ideas.

Alberto D. Cuellar, MD, of Houston, noted the staggering impact of healthcare expenses on the federal budget and called for an alternative that would uncouple the financial relationship between physicians and government.

Neil T. Katz, MD, of Beverly Hills, Fla., raised the issue of antitrust legislation, both as it applies to insurance companies and as it applies to physicians. Mr. Lovett responded that the AAOS supports collective negotiation rights for physicians.

Several members raised the issue of medical liability reform. Recent data from the Congressional Budget Office seem to indicate that medical liability reform could have a substantial impact in reducing healthcare costs.

The question of treating the uninsured and providing uncompensated care was also raised. Mr. Lovett proposed that physicians receive a tax credit or be allowed a tax write-off for providing uncompensated care.

Finally, several international affiliates pointed to the fact that several options exist for providing universal coverage. But, as Dr. Zuckerman noted, these countries have “grown up” with these different systems; making such a change in the United States would require a massive societal recon¬≠figuration.