A Resident's Viewpoint: Health Care Reform and the Election

Whether by an ‘Occupation’, a ‘Tea Party’ or continued ‘Change,’ the 2012 national Senate, House and Presidential elections will affect cardiothoracic surgeons in the United States. Twenty-three of the total thirty three senate seats up for election this cycle belong to the Democratic party and were key to the passing of health care reform. Through multiple fronts the elections will change patient access, tax laws, and future regulatory policy for the nation. This article will review key health care disputes likely to be decided by the results of the next election cycle. These should be of key concern to residents, as they are likely to impact dramatically their future careers.

The Patient Protection and Affordable Care Act (PPACA), even if repealed by Republican challengers, will change the face of cardiothoracic surgery. Patient groups such as adults with histories of congenital heart defects, cancer survivors, and arteriopaths will be among many others directly affected by every governing seat that does or does not change.

Health care reform of any flavor, however economically viewed, will increase the amount of patients that qualify for physician care in the United States. In the field of cardiothoracic surgery, this numerical challenge will fly in the face of a medical field with relatively decreasing numbers and increasing scrutiny for quality results.

Paying for health care reform is of course the most heated debate during the 2012 election cycle. The Act’s provisions are intended to be funded by a variety of taxes and offsets. Major sources of new revenue include a much broadened Medicare tax on incomes over $200,000 and $250,00, for individual and joint filers respectively (adding $210 billion in total), an annual fee on insurance providers ($60 billion), and a 40% tax on the "Cadillac" insurance policies ($32 billion).

There are also taxes on pharmaceuticals, outlier diagnostic equipment ($47 billion) and an increase of tax on services deemed to threaten health such as tanning beds. The patient mandate, key to the plans financial viability, is at the heart of the judicial and economic debate.

The run up to the election will include a decision by the Supreme Court likely in June to approve, partially approve or completely refute the current bill.

The patient mandate though is a small part of the fundamental changes that are occurring with the current payer/payee system. Many aspects of the PPACA have already been phased in with more coming in 2012. The majority of the moves will occur in the administrative offices of clinics and hospitals as quality measures, patient satisfaction, and efficiency drive the shift away from fee for service.

Republican challengers have countered these tax increases with alternatives that favor increasing competition into the health care market. Permitting insurance companies to compete across state lines is one example of this method. In place of a mandate, Republicans have sought to expand tax deductions to individuals who purchase their own insurance and expand Health Savings Accounts so they can be used on insurance premiums.

To indemnify the individual, they favor individuals and small business forming purchasing pools lowering insurance costs. An April 3rd New York Times article has highlighted the fact though that the Republicans have yet to agree on an overall alternative to the PPACA should it be struck down by the Supreme Court.

Controversies of access such as those seen earlier this year in debates on paying for birth control have so far not occurred within the field of cardiothoracic surgery. Controversy of access within cardiothoracic surgery is likely to be monetary. Societal pressures to control costs have and will continue to question expenditures at the extreme ends of life. Services with high up-front costs such as ventricular assist devices, transplants ,and innovative chemotherapy regimens will need to run a gauntlet in an atmosphere increasingly hostile to inefficiency.

Consolidation of care with quality measures aimed at the disease as a whole rather than one individual procedure underline the importance of being on a winning team, not just being the star player. The best, but not solitary, example of this consolidation is the phase in of the Accountable Care Organizations (ACOs).

If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save. Again consolidation linked to increased quality. Another example is the Medicare Value-Based Purchasing Program (VBP) that will link payments made by Medicare to the quality of the outcome they achieve. Often cited in the debate is the fact that 1 out of 3 Medicare patients are readmitted a month after they have been discharged.

The VBP program will provide financial incentive to decrease hospital recidivism. Linking quality measures to compensation is popular with both parties and unlikely to be repealed.

Insurance companies are also facing regulatory changes to increase efficiency and quality. Medical loss ratio (MLR) requirements of the PPACA will issue rebates to customers whose insurance companies fail to spend 80% of premium dollars received from individual and small business policy holders to improving care.

Of great interest to the insurance industry is if the mandate is struck down, and they are still required to supply insurance regardless of age or past history of disease. With no incentive to have health insurance until sick, the unequal ratio of healthy to sick patients will cause premiums to skyrocket. Ironically a proposed insurance industry alternative to the mandate is for the industry to gain the right to penalize those not signing up for coverage.

Outside of voting and direct campaigning, the surgeon is represented directly or indirectly through multiple Political Action Committees (PACs). Specific to the cardiothoracic surgeon is the Society of Thoracic Surgeon’s (STS) PAC. The STS Political Action Committee has raised $196,000 so far this election cycle with $32,000 being raised at the STS 48th Annual Meeting in Fort Lauderdale alone.

Recently, the STS PAC has joined other medical societies in expressing to CMS a concern about the simultaneous implementation of multiple programs that will create extraordinary financial and administrative burden as well as mass confusion for physicians. Programs such as the value based modifier, electronic prescribing, and electronic health record incentive will all go online simultaneously which some worry may lead to a meltdown at the clinical level.

The STS PAC also continues to advocate for a permanent SGR repeal that would avoid a 20%-30% decrease in Medicare reimbursements. As the health care industrial complex transforms, the PAC will strive to allow physicians generating savings by quality improvements to keep their share rather than have it be siphoned off to pay for alternative expenditures.

The STS has developed excellent tools and information to help the surgeon have their individual voice heard at the national level. The website, sts.org/advocacy/get-involved, includes suggestions and a kit to reach out to others and encourage citizen participation.

In the end this election will be one where expenditures and the health of America are tied together like no other election cycle. More than the findings of any randomized controlled study, changes in medical access, distribution of funds, and markers of quality will all follow the electoral results.

Dr. Robroy MacIver is a pediatric cardiothoracic surgery fellow at Seattle Children’s Hospital and a resident editor of Thoracic Surgery News.

Whether by an ‘Occupation’, a ‘Tea Party’ or continued ‘Change,’ the 2012 national Senate, House and Presidential elections will affect cardiothoracic surgeons in the United States. Twenty-three of the total thirty three senate seats up for election this cycle belong to the Democratic party and were key to the passing of health care reform. Through multiple fronts the elections will change patient access, tax laws, and future regulatory policy for the nation. This article will review key health care disputes likely to be decided by the results of the next election cycle. These should be of key concern to residents, as they are likely to impact dramatically their future careers.

The Patient Protection and Affordable Care Act (PPACA), even if repealed by Republican challengers, will change the face of cardiothoracic surgery. Patient groups such as adults with histories of congenital heart defects, cancer survivors, and arteriopaths will be among many others directly affected by every governing seat that does or does not change.

Health care reform of any flavor, however economically viewed, will increase the amount of patients that qualify for physician care in the United States. In the field of cardiothoracic surgery, this numerical challenge will fly in the face of a medical field with relatively decreasing numbers and increasing scrutiny for quality results.

Paying for health care reform is of course the most heated debate during the 2012 election cycle. The Act’s provisions are intended to be funded by a variety of taxes and offsets. Major sources of new revenue include a much broadened Medicare tax on incomes over $200,000 and $250,00, for individual and joint filers respectively (adding $210 billion in total), an annual fee on insurance providers ($60 billion), and a 40% tax on the "Cadillac" insurance policies ($32 billion).

There are also taxes on pharmaceuticals, outlier diagnostic equipment ($47 billion) and an increase of tax on services deemed to threaten health such as tanning beds. The patient mandate, key to the plans financial viability, is at the heart of the judicial and economic debate.

The run up to the election will include a decision by the Supreme Court likely in June to approve, partially approve or completely refute the current bill.

The patient mandate though is a small part of the fundamental changes that are occurring with the current payer/payee system. Many aspects of the PPACA have already been phased in with more coming in 2012. The majority of the moves will occur in the administrative offices of clinics and hospitals as quality measures, patient satisfaction, and efficiency drive the shift away from fee for service.

Republican challengers have countered these tax increases with alternatives that favor increasing competition into the health care market. Permitting insurance companies to compete across state lines is one example of this method. In place of a mandate, Republicans have sought to expand tax deductions to individuals who purchase their own insurance and expand Health Savings Accounts so they can be used on insurance premiums.

To indemnify the individual, they favor individuals and small business forming purchasing pools lowering insurance costs. An April 3rd New York Times article has highlighted the fact though that the Republicans have yet to agree on an overall alternative to the PPACA should it be struck down by the Supreme Court.

Controversies of access such as those seen earlier this year in debates on paying for birth control have so far not occurred within the field of cardiothoracic surgery. Controversy of access within cardiothoracic surgery is likely to be monetary. Societal pressures to control costs have and will continue to question expenditures at the extreme ends of life. Services with high up-front costs such as ventricular assist devices, transplants ,and innovative chemotherapy regimens will need to run a gauntlet in an atmosphere increasingly hostile to inefficiency.

Consolidation of care with quality measures aimed at the disease as a whole rather than one individual procedure underline the importance of being on a winning team, not just being the star player. The best, but not solitary, example of this consolidation is the phase in of the Accountable Care Organizations (ACOs).

If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save. Again consolidation linked to increased quality. Another example is the Medicare Value-Based Purchasing Program (VBP) that will link payments made by Medicare to the quality of the outcome they achieve. Often cited in the debate is the fact that 1 out of 3 Medicare patients are readmitted a month after they have been discharged.

The VBP program will provide financial incentive to decrease hospital recidivism. Linking quality measures to compensation is popular with both parties and unlikely to be repealed.

Insurance companies are also facing regulatory changes to increase efficiency and quality. Medical loss ratio (MLR) requirements of the PPACA will issue rebates to customers whose insurance companies fail to spend 80% of premium dollars received from individual and small business policy holders to improving care.

Of great interest to the insurance industry is if the mandate is struck down, and they are still required to supply insurance regardless of age or past history of disease. With no incentive to have health insurance until sick, the unequal ratio of healthy to sick patients will cause premiums to skyrocket. Ironically a proposed insurance industry alternative to the mandate is for the industry to gain the right to penalize those not signing up for coverage.

Outside of voting and direct campaigning, the surgeon is represented directly or indirectly through multiple Political Action Committees (PACs). Specific to the cardiothoracic surgeon is the Society of Thoracic Surgeon’s (STS) PAC. The STS Political Action Committee has raised $196,000 so far this election cycle with $32,000 being raised at the STS 48th Annual Meeting in Fort Lauderdale alone.

Recently, the STS PAC has joined other medical societies in expressing to CMS a concern about the simultaneous implementation of multiple programs that will create extraordinary financial and administrative burden as well as mass confusion for physicians. Programs such as the value based modifier, electronic prescribing, and electronic health record incentive will all go online simultaneously which some worry may lead to a meltdown at the clinical level.

The STS PAC also continues to advocate for a permanent SGR repeal that would avoid a 20%-30% decrease in Medicare reimbursements. As the health care industrial complex transforms, the PAC will strive to allow physicians generating savings by quality improvements to keep their share rather than have it be siphoned off to pay for alternative expenditures.

The STS has developed excellent tools and information to help the surgeon have their individual voice heard at the national level. The website, sts.org/advocacy/get-involved, includes suggestions and a kit to reach out to others and encourage citizen participation.

In the end this election will be one where expenditures and the health of America are tied together like no other election cycle. More than the findings of any randomized controlled study, changes in medical access, distribution of funds, and markers of quality will all follow the electoral results.

Dr. Robroy MacIver is a pediatric cardiothoracic surgery fellow at Seattle Children’s Hospital and a resident editor of Thoracic Surgery News.

Whether by an ‘Occupation’, a ‘Tea Party’ or continued ‘Change,’ the 2012 national Senate, House and Presidential elections will affect cardiothoracic surgeons in the United States. Twenty-three of the total thirty three senate seats up for election this cycle belong to the Democratic party and were key to the passing of health care reform. Through multiple fronts the elections will change patient access, tax laws, and future regulatory policy for the nation. This article will review key health care disputes likely to be decided by the results of the next election cycle. These should be of key concern to residents, as they are likely to impact dramatically their future careers.

The Patient Protection and Affordable Care Act (PPACA), even if repealed by Republican challengers, will change the face of cardiothoracic surgery. Patient groups such as adults with histories of congenital heart defects, cancer survivors, and arteriopaths will be among many others directly affected by every governing seat that does or does not change.

Health care reform of any flavor, however economically viewed, will increase the amount of patients that qualify for physician care in the United States. In the field of cardiothoracic surgery, this numerical challenge will fly in the face of a medical field with relatively decreasing numbers and increasing scrutiny for quality results.

Paying for health care reform is of course the most heated debate during the 2012 election cycle. The Act’s provisions are intended to be funded by a variety of taxes and offsets. Major sources of new revenue include a much broadened Medicare tax on incomes over $200,000 and $250,00, for individual and joint filers respectively (adding $210 billion in total), an annual fee on insurance providers ($60 billion), and a 40% tax on the "Cadillac" insurance policies ($32 billion).

There are also taxes on pharmaceuticals, outlier diagnostic equipment ($47 billion) and an increase of tax on services deemed to threaten health such as tanning beds. The patient mandate, key to the plans financial viability, is at the heart of the judicial and economic debate.

The run up to the election will include a decision by the Supreme Court likely in June to approve, partially approve or completely refute the current bill.

The patient mandate though is a small part of the fundamental changes that are occurring with the current payer/payee system. Many aspects of the PPACA have already been phased in with more coming in 2012. The majority of the moves will occur in the administrative offices of clinics and hospitals as quality measures, patient satisfaction, and efficiency drive the shift away from fee for service.

Republican challengers have countered these tax increases with alternatives that favor increasing competition into the health care market. Permitting insurance companies to compete across state lines is one example of this method. In place of a mandate, Republicans have sought to expand tax deductions to individuals who purchase their own insurance and expand Health Savings Accounts so they can be used on insurance premiums.

To indemnify the individual, they favor individuals and small business forming purchasing pools lowering insurance costs. An April 3rd New York Times article has highlighted the fact though that the Republicans have yet to agree on an overall alternative to the PPACA should it be struck down by the Supreme Court.

Controversies of access such as those seen earlier this year in debates on paying for birth control have so far not occurred within the field of cardiothoracic surgery. Controversy of access within cardiothoracic surgery is likely to be monetary. Societal pressures to control costs have and will continue to question expenditures at the extreme ends of life. Services with high up-front costs such as ventricular assist devices, transplants ,and innovative chemotherapy regimens will need to run a gauntlet in an atmosphere increasingly hostile to inefficiency.

Consolidation of care with quality measures aimed at the disease as a whole rather than one individual procedure underline the importance of being on a winning team, not just being the star player. The best, but not solitary, example of this consolidation is the phase in of the Accountable Care Organizations (ACOs).

If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save. Again consolidation linked to increased quality. Another example is the Medicare Value-Based Purchasing Program (VBP) that will link payments made by Medicare to the quality of the outcome they achieve. Often cited in the debate is the fact that 1 out of 3 Medicare patients are readmitted a month after they have been discharged.

The VBP program will provide financial incentive to decrease hospital recidivism. Linking quality measures to compensation is popular with both parties and unlikely to be repealed.

Insurance companies are also facing regulatory changes to increase efficiency and quality. Medical loss ratio (MLR) requirements of the PPACA will issue rebates to customers whose insurance companies fail to spend 80% of premium dollars received from individual and small business policy holders to improving care.

Of great interest to the insurance industry is if the mandate is struck down, and they are still required to supply insurance regardless of age or past history of disease. With no incentive to have health insurance until sick, the unequal ratio of healthy to sick patients will cause premiums to skyrocket. Ironically a proposed insurance industry alternative to the mandate is for the industry to gain the right to penalize those not signing up for coverage.

Outside of voting and direct campaigning, the surgeon is represented directly or indirectly through multiple Political Action Committees (PACs). Specific to the cardiothoracic surgeon is the Society of Thoracic Surgeon’s (STS) PAC. The STS Political Action Committee has raised $196,000 so far this election cycle with $32,000 being raised at the STS 48th Annual Meeting in Fort Lauderdale alone.

Recently, the STS PAC has joined other medical societies in expressing to CMS a concern about the simultaneous implementation of multiple programs that will create extraordinary financial and administrative burden as well as mass confusion for physicians. Programs such as the value based modifier, electronic prescribing, and electronic health record incentive will all go online simultaneously which some worry may lead to a meltdown at the clinical level.

The STS PAC also continues to advocate for a permanent SGR repeal that would avoid a 20%-30% decrease in Medicare reimbursements. As the health care industrial complex transforms, the PAC will strive to allow physicians generating savings by quality improvements to keep their share rather than have it be siphoned off to pay for alternative expenditures.

The STS has developed excellent tools and information to help the surgeon have their individual voice heard at the national level. The website, sts.org/advocacy/get-involved, includes suggestions and a kit to reach out to others and encourage citizen participation.

In the end this election will be one where expenditures and the health of America are tied together like no other election cycle. More than the findings of any randomized controlled study, changes in medical access, distribution of funds, and markers of quality will all follow the electoral results.

Dr. Robroy MacIver is a pediatric cardiothoracic surgery fellow at Seattle Children’s Hospital and a resident editor of Thoracic Surgery News.