Commentary

Be part of the health care debate in 2020

The last decade of health care has seen incredible changes, beginning with the passage of the Affordable Care Act in 2010. The law has been challenged, altered and amended numerous times. Yet, it still has many unsettled issues and the cost of health care continues to increase.

Health care issues in the United States will be a primary focus of the 2020 presidential election. Widely differing proposals, such as Medicare For All, vs. the maintenance of the current system with less federal support and more support leveraged on states will be debated. The ACA will not be repealed due to the current balance of power in government, and Medicare for All will not be passed because most Americans prefer to hold onto the private health insurance from employer-sponsored plans. There may be room to create a public option health plan that has Medicare fee schedules and networks to reduce the number of uninsured. However, it will not approach 100% coverage without the currently unpalatable component of a significant government subsidy.

Bipartisan priorities

Anthony A. Romeo

With a stagnation of federal solutions to health care problems, due in large part to a divided Congress, bipartisan priorities will affect our practices. Congress is united in its effort to control the opioid epidemic, which has fostered new approaches to perioperative pain management. Orthopedic surgeons need to be involved in the decisions as we support the need to confront the U.S. opioid epidemic.

Another important bipartisan issue is surprise medical billing. Out-of-network billing, even when care is delivered at an in-network facility, has increased during the past decade, especially with emergency room care. In response to patient advocacy groups, different solutions have been proposed, including setting standards for out-of-network billing based on some percentage of in-network billing. Some payers will use this leverage to affect the fee schedule with providers, moving the rates lower or cancelling contracts, adversely affecting the negotiation process for physicians and other health care providers.

The American Academy of Ortho-paedic Surgeons has proposed an arbitration system or an independent dispute resolution process. Concerns remain on both sides of the discussion, with some suggesting this should be tethered to the health care price transparency effort from the Trump administration, making patients aware of costs. This movement is gaining momentum, although hospitals and health care systems are gearing up for a complicated and lengthy legal battle over the issue. Furthermore, price transparency won’t be effective in the face of emergency care.

Without question, health care reform 10 years after the passage of the ACA remains contentious, challenging and critical to our ability to practice orthopedic surgery in the manner we believe best for patients. Without even considering the numerous issues centered around CMS’ plan to change the way we bill for patient encounters, allowing traditionally inpatient procedures to be done in an ambulatory surgery setting, it is clear we need to be engaged and involved in the political process in which decisions made affect our everyday life. This is an uphill battle when we consider the amount of money hospitals, insurance companies and the pharmaceutical industry spend in their lobbying efforts. However, the ability to affect the legislative agenda of elected officials should not be underestimated by anyone in orthopedic surgery.

An orthopedic surgeon’s scheduled visit with a state representative or to Capitol Hill confirms that our voices have influence. We have had successful lobbying efforts throughout the United States and in Washington, D.C. the past few years. Additionally, more health care decisions are made at the state level, where many members of state orthopedic societies have personal contacts, which provide valuable opportunities to discuss our views and recommendations directly with elected officials.

Health care will be a top issue debated in the 2020 presidential election. Our voice needs to be part of the debate. Our passion for orthopedics, our stories of positive change in people’s lives with orthopedic care, our ability to communicate and the respect politicians have for surgeons have powerful impacts.

If we sit on the sidelines and let the other stakeholders in the debate lead the discussion and ultimately influence key decisions, then we are giving away opportunities at a key moment to positively shape the delivery of musculoskeletal care to patients that reflects our vision for quality and value.

Disclosure: Romeo reports he receives royalties, is on the speakers bureau, is a consultant and does contracted research for Arthrex; receives institutional grants from MLB; and receives institutional research support from Arthrex, Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Wright Medical.

The last decade of health care has seen incredible changes, beginning with the passage of the Affordable Care Act in 2010. The law has been challenged, altered and amended numerous times. Yet, it still has many unsettled issues and the cost of health care continues to increase.

Health care issues in the United States will be a primary focus of the 2020 presidential election. Widely differing proposals, such as Medicare For All, vs. the maintenance of the current system with less federal support and more support leveraged on states will be debated. The ACA will not be repealed due to the current balance of power in government, and Medicare for All will not be passed because most Americans prefer to hold onto the private health insurance from employer-sponsored plans. There may be room to create a public option health plan that has Medicare fee schedules and networks to reduce the number of uninsured. However, it will not approach 100% coverage without the currently unpalatable component of a significant government subsidy.

Bipartisan priorities

Anthony A. Romeo

With a stagnation of federal solutions to health care problems, due in large part to a divided Congress, bipartisan priorities will affect our practices. Congress is united in its effort to control the opioid epidemic, which has fostered new approaches to perioperative pain management. Orthopedic surgeons need to be involved in the decisions as we support the need to confront the U.S. opioid epidemic.

Another important bipartisan issue is surprise medical billing. Out-of-network billing, even when care is delivered at an in-network facility, has increased during the past decade, especially with emergency room care. In response to patient advocacy groups, different solutions have been proposed, including setting standards for out-of-network billing based on some percentage of in-network billing. Some payers will use this leverage to affect the fee schedule with providers, moving the rates lower or cancelling contracts, adversely affecting the negotiation process for physicians and other health care providers.

The American Academy of Ortho-paedic Surgeons has proposed an arbitration system or an independent dispute resolution process. Concerns remain on both sides of the discussion, with some suggesting this should be tethered to the health care price transparency effort from the Trump administration, making patients aware of costs. This movement is gaining momentum, although hospitals and health care systems are gearing up for a complicated and lengthy legal battle over the issue. Furthermore, price transparency won’t be effective in the face of emergency care.

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Without question, health care reform 10 years after the passage of the ACA remains contentious, challenging and critical to our ability to practice orthopedic surgery in the manner we believe best for patients. Without even considering the numerous issues centered around CMS’ plan to change the way we bill for patient encounters, allowing traditionally inpatient procedures to be done in an ambulatory surgery setting, it is clear we need to be engaged and involved in the political process in which decisions made affect our everyday life. This is an uphill battle when we consider the amount of money hospitals, insurance companies and the pharmaceutical industry spend in their lobbying efforts. However, the ability to affect the legislative agenda of elected officials should not be underestimated by anyone in orthopedic surgery.

An orthopedic surgeon’s scheduled visit with a state representative or to Capitol Hill confirms that our voices have influence. We have had successful lobbying efforts throughout the United States and in Washington, D.C. the past few years. Additionally, more health care decisions are made at the state level, where many members of state orthopedic societies have personal contacts, which provide valuable opportunities to discuss our views and recommendations directly with elected officials.

Health care will be a top issue debated in the 2020 presidential election. Our voice needs to be part of the debate. Our passion for orthopedics, our stories of positive change in people’s lives with orthopedic care, our ability to communicate and the respect politicians have for surgeons have powerful impacts.

If we sit on the sidelines and let the other stakeholders in the debate lead the discussion and ultimately influence key decisions, then we are giving away opportunities at a key moment to positively shape the delivery of musculoskeletal care to patients that reflects our vision for quality and value.

Disclosure: Romeo reports he receives royalties, is on the speakers bureau, is a consultant and does contracted research for Arthrex; receives institutional grants from MLB; and receives institutional research support from Arthrex, Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Wright Medical.

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