Policy Experts Parse Implications of Health Care Reform

The regionalization of health systems offers an opportunity for different models of surgical care, he suggested. Surgeons and high-technology equipment may locate more in regional centers than individual practices.

Government programs could do more to increase the supply of surgeons, added Dr. Sheldon, professor of surgery at the University of North Carolina at Chapel Hill. The National Health Service Corps doesn’t include surgeons, "but it would be great if they did," he said.

Creating new medical schools – and somehow finding the residency programs to train the extra graduates – is a good long-term plan, but it doesn’t solve immediate workforce shortages, said Dr. Andrew L. Warshaw, chair of the ACS Health Policy Advisory Group. "If we have shortages now, it will be worse" as the ACA is implemented, he said in a presentation during the session. He noted that such shortages occurred in Massachusetts after the state adopted universal health care coverage.

Greater use of mid-level providers may help extend physicians’ reach, and regionalization models can either put more physicians where they’re needed or bring patients to physicians’ locations, he suggested.

But physicians need to tackle costs of health care, added Dr. Warshaw, of Harvard Medical School, Boston. If any solutions include a fix of the Sustainable Growth Rate (SGR) formula as requested by physicians, $1.6 trillion instead of $1.2 trillion would have to be cut from the federal deficit – cuts that could come from other parts of health care.

"What can surgeons do?" Dr. Warshaw said. "Every person in this room needs to do something, somewhere, somehow within your own practice to figure out what’s the right kind of care to give your patients. There’s good evidence that that can go a long way toward paying down the SGR."

If postoperative complications cost an average of $10,000, preventing just one postoperative complication per day at every U.S. hospital would reduce costs by $125-$250 billion over 10 years, he estimated.

Surgeons also need to figure out optimal care for patients and demand that other specialties do the same. One study at Massachusetts General Hospital found that physicians ordered between 1 and 30 CAT scans for patients seen in the emergency department for head trauma. Such a wide range in practices is "wrong," he said. "It’s our job to figure this out." Medical liability reform potentially could save another $62 billion in health care costs over 10 years, he added.

"I don’t think we can count on the ACA to reduce costs. We have to do a lot more," Dr. Warshaw said. "There’s a huge amount going on, and it’s way ahead of the Affordable Care Act in many ways."

Dr. Detmer has consulted for CS Placement. Dr. Ricketts, Dr. Sheldon, and Dr. Warshaw said that they had no financial conflicts. ☐