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Health Care Reform
Sunday, 31 May 2009 00:00



Health care reform is on everyone’s mind, from President Obama trying to figure out how to solve a crisis to the un-insured barely making ends meet….from the Medicare patient wondering if he/she will have adequate coverage to the growing number of medical providers wondering if reimbursements will continue to drop.  Here is my take as a practicing orthopedic surgeon.


While it would be wonderful for every American to have affordable health insurance, there are certain things that the “experts” in Washington seem to be overlooking. First, as a culture, we are used to having access to the best care in a timely fashion. Under a nationalized plan, would that still be the case?  Or will it be like the United Kingdom and Canada where patients get on a waiting list that is months long to have their ACL reconstruction or their knee replacement?  Will Americans be ok with that?  Personally I don’t think so.



Second, an alarmingly growing trend is physicians dropping their contracts with Medicare. In other words if you are insured by Medicare and want to see a physician who is not a Medicare provider, you have to pay cash out of pocket at what would be considered fair market value for an office visit or procedure. This is unrealistic for many of our country’s aging population. But what is a physician to do?  The current Medicare fee schedule fails to provide a high enough level of reimbursement for any orthopedist to run a financially successful practice.  Fortunately for me the Medicare segment of my practice is subsidized by having other payor sources. That is not the case for many primary care physicians, for whom Medicare is their greatest source of patients, but who have had to close their business because they are losing money by continuing to practice.  In the Phoenix metropolitan area, many Medicare insured patients are having a hard time finding a primary care doctor…..that is sad.


If reimbursement rates continue to drop, I anticipate that a growing number of orthopedic surgeons will opt out of providing care to Medicare patients…..if that is true, where will grandma, grandpa, mom, & dad go for their hip and knee replacements??


A change is needed and I don’t have a solution; I just wanted to bring to light some issues that I don’t seem to be hearing on the news or reading in the paper.


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