Dr. Resnick Goes to Washington With a Vision

Dan Resnick, M.D. is the First Vice President of the North American Spine Society (NASS). In October, he will become the Society’s President.

In the 2017 July/August edition of SpineLine, Resnick writes an editorial titled, Politics, Practice and Professionalism. His views on politics and public policy are timely given there is an administration in Washington, D.C. which has promised to repeal the Affordable Care Act and an orthopedic surgeon at the helm of the Department of Health and Human Services (HHS) who has promised to make federal healthcare programs more surgeon friendly.

“We live in interesting times,” writes Resnick as he travels to Washington to participate in a fly-in of medical specialties to confer with HHS Secretary Tom Price, M.D. and one of his home state representatives, House Speaker Paul Ryan of Wisconsin. “We are faced with a potential re-organization of government involvement in medical care.”

He wants to talk about the problems that “Obamacare” has created for surgeons on the front lines. He specifically notes the costs associated with mandated use of electronic health record (EHR) systems, “that are not actually health record systems.” He notes “frustrations related to the lack of interoperability of these systems, and frustration related to the explosion in ‘quality improvement’ reporting requirements which are burdensome yet have no demonstrated value in actually improving quality.”

A History of Meddling

“Meddling” by organized medicine in politics and politicians meddling in medicine goes back a long way, he writes as he turns historian. He cites the “doomsayers” who have decried the death of medical specialties at the hands of the government and points to organized medicine’s “vigorous” opposition to the creation of Medicare in the 1960s. He said the message was that government-run medicine is socialism which undermines American freedom. He says there was a “significant concern that ‘compulsory security’ would take away individual responsibility and lead to a ‘weakening of national caliber’ and undue uninformed interference with the patient/physician relationship.”

The actual result, writes Resnick, is that Medicare became “a tremendous cash cow” to physicians. More people were now covered for medical care and with FICA contributions the only cost for seeking such care, more care was sought and more care was delivered. “Physicians were making a great living. What’s not to love?”

But the down side for physicians was the unsustainable Sustainable Growth Rater (SGR) formula which was not related to medical need, but to budgetary concerns. Physicians had to threaten to abandon Medicare patients to get Congress to enact yearly “doc fixes.”

Then came Obama and the American Medical Association’s (AMA) “surprising” support of the Affordable Care Act. Resnick writes that “some journalists” suggested that the AMA is more responsive to the needs of the government than to its members due to its heavy reliance on Centers for Medicare and Medicaid Services (CMS) funds received for management of the CPT (current procedural terminology) process.

So, what happened to incomes of physicians after the passage of the ACA?

Unexpectedly, says Resnick, after a decade of flat income, median income for primary care specialties has risen 10%-15% and most subspecialties have seen similar gains. This is driven by, again, more consumption of health services, but now also by competition between health systems to garner market share of patient populations. The reform of the healthcare system also did away with the SGR.

But this time the cost to physicians is not about money, but about a “substantial and potentially dangerous” loss of autonomy as subspecialists are now employed by medical systems. “The patient/physician relationship has been permanently changed through the mandated use of electronic billing systems and the mandated reporting of process measures.” This has a big impact on physician morale and patient satisfaction.

Dr. Resnick’s Vision

Resnick would love to see support for the measurement of “true patient outcomes” and the “institutionalization of relevant specialty-based quality measures.” Mostly he’d like to spend less time clicking boxes on his computer and more time fixing patients. He’d like to see physicians exempt from legal liability of he or she adheres to clinical practice guidelines.

He thinks measuring true quality, reducing reporting burdens and reducing defensive medicine are a “good start.”

Dr. Resnick is bringing his vision to Washington, a place where vision takes a back seat to the next election.