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

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 Linking quality measures to compensation is popular with both parties and unlikely to be repealed.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.