8 Key Issues for Specialists

Alex B. Valadka, MD, is a Houston neurosurgeon and spokesperson for the Alliance of Specialty Medicine. The alliance was involved in discussions with drafters of the healthcare reform bill and continues to work with Congress on healthcare issues. Here he discusses eight key issues for specialists.

1. Allow ACOs for specialty care. "There should be enough flexibility to allow for development of ACOs devoted to one condition, such as back pain," Dr. Valadka says. If accountable care organizations are to achieve new efficiencies, they need to allow direct access to specialists for evaluation and treatment. When patients go to primary care physicians for specialty care, they sometimes get unnecessary services, such as expensive MRI scans when there are other ways to diagnose symptoms.

Besides, "in many cases, when you have a certain condition, you already know what specialist to see," he says. "If you have blurry vision, you see an ophthalmologist. If you have irritable bowel syndrome, you would go to a gastroenterologist."  

2. Hospital employment can work. When hospitals employ specialists, they tend to have good relations with the ones they are dependent on for service lines, such as neurosurgeons, cardiologists and orthopedic surgeons. "If specialists understand what they are getting into, it can work," Dr. Valadka says. "Specialists need to be able to work with the hospital on improving quality and reducing costs. But if the specialist climbs on board for a salary guarantee for a few years, it's not going to work."

3. Fix the SGR, permanently. The sustainable growth rate payment formula should be eliminated, and the extra cost could be offset this cost with medical liability reform. "The SGR formula is a joke," Dr. Valadka says. "You can't run a business when you don't know if there will be a 23 percent drop in income." So far Congress has averted a permanent fee-cut, but it has allowed short-term fee-cuts to go into effect, forcing practices to resubmit claims to get the cut fees.

4. Tort reform can reduce healthcare costs. The healthcare reform law skirted comprehensive reform of the malpractice system, even though it is a good way to reduce healthcare costs. In addition to protecting physicians from unaffordable liability premiums, medical liability reform can help achieve health system savings by reducing incentives for defensive medicine.

5. Eliminate the Independent Payment Advisory Board. It is dangerous to put unelected officials in charge of recommending vast Medicare spending cuts. "Government bureaucrats will have incredible power over the medical decisions senior citizens make," Dr. Valadka says. "If the Board decides that certain procedures are too costly, or they refuse to pay for reasonable expenses, then seniors will be caught on the short end of the stick. For this reason alone, IPAB must be repealed."

6. Encourage specialty hospitals, don't ban them. The freeze on building new specialty hospitals and expanding existing ones does not make any sense as healthcare policy. The emergence of ASCs and specialty hospitals shows that a lot of specialty care can be done at lower costs outside the traditional hospital without lowering quality.

7. Don’t pay generalists more at specialists' expense.
Primary care physicians work hard and deserve higher reimbursements, but generalists' raise shouldn't come at the expense of specialists. "You don't want to rob Peter to pay Paul," Dr. Valadka says. "Increasingly, specialists are having the same problems as primary care physicians."

8. The AMA should get back on track. "The AMA faces a problem," Dr. Valadka says. "Is it really speaking for its members?" The organization endorsed the healthcare reform bill under the premise that it would include a permanent fee fix, but the price tag was too much for Congress to swallow. "Now AMA members are trying to right the ship," he says. Next year, for the first time, a neurosurgeon will lead the AMA. Peter W. Carmel, MD, of New Jersey, was named president elect in June. As a large, complex organization that represents all physicians, the AMA inevitably needs to do a great deal of compromising, but it has to be careful about going too far.

Learn more about the Alliance of Specialty Medicine.

Read more coverage on specialists:

-National Coordinator David Blumenthal Assures Specialists Can Meet Meaningful Use Requirements

-Specialists Alliance Questions Debt Panel's Plan for Medicare Fees

-Study: Potential Problems With Role of Physicians and Specialists in Medical Home Model


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