Rep. Tom Price, MD, outlines an alternative vision for healthcare reform

Orthopaedic surgeon and Congressional representative from Georgia’s 6th District, Tom Price, MD, calls himself a “triple R” guy, who wants to “replace the people that voted for the healthcare reform bill, repeal the bill, and reform it with appropriate patient-centered health care.”

AAOS Now: What’s your assessment of the healthcare reform bill?

Dr. Price: Well, the problem with the bill that was passed and signed into law is that it’s built on a flawed foundation—the individual mandate. That’s how it solves the big challenges of coverage, portability, pre-existing conditions—all those issues. I think that it is fundamentally unconstitutional and flawed.

What we need is a more patient-centered way to solve those problems. We need to address pre-existing illnesses and injuries, not in a way that mandates what people have to do, but in a way that actually solves it so that patients get to select the coverage that they want. Would we make certain that young people up to the age of 26 have health coverage? Absolutely. But we would do it in a different way.

AAOS Now: So, what would be the next step—the November elections?

Dr. Price: Yes. We need different folks at the table so that there are checks and balances. The American people are so angry because they see runaway government to the left, and they don’t recognize the normal give and take—as ugly as that can be—that then comes together to solve the challenge. I think the American people will put those checks and balances in place, and then our challenge is to move forward positively and in a direction that patients want.

AAOS Now: You talk about changing the Sustainable Growth Rate (SGR) formula from a reimbursement to a payment. What difference will that make?

Dr. Price: At a minimum, that’s what has to occur. This notion that the federal government ought to be the one entity setting fees for the physicians of this country is nonsense. It can never get to the right answer. This wasn’t the grand design 40 years ago when the federal government began to increase its intervention into health care. But it’s where we are now.

At some point, we have to get back to the fundamental patient/physician relationship, where the patient wants the service, the physician desires to provide that service, and they agree on a price for that service. If that fundamental principle isn’t part of the system, there’s no release valve for the pressure that builds up and you get physicians virtually working for the government, as opposed to working for the patient. In some practices, upwards of 60 percent to 80 percent of the patient population is on Medicare or Medicaid. I take my hat off to those folks; I don’t understand how they can survive.

AAOS Now: You’ve also said that you can’t do healthcare reform without tort reform.

Dr. Price: The whole issue of lawsuit abuse absolutely needs to be done in the context of health reform. There was a significant survey recently that estimated that one out of every four dollars in the healthcare system is spent on the practice of defensive medicine—that’s $600 billion.

Defensive medicine is destructive not just to the practice of medicine but also to the costs of health care in our country. At some level, it’s destructive to the level of trust between patient and physician. We must have lawsuit abuse reform, as we tried to capture that in HR3400.

AAOS Now: What about the workforce issue? Do you see any future in private practice?

Dr. Price: Well, I think there has to be a future in private practice, because it’s another release valve for the entire system. I understand that most younger people coming into health care now view their ideal work situation as an employed physician. That’s a lot different than when I was in medical school and residency.

Most medical students 30 years ago thought that they would go into private practice, in a community in the way that gives them the greatest amount of autonomy. But that’s different now—not good or bad, just different. But unless you have the right to continue a private practice in the system, there are no checks on those who are setting the rules of the game. It just becomes a job, not a profession.

AAOS Now: What are your thoughts on trauma care and funding for trauma research?

Dr. Price: I’ve been a big proponent of changing the way that the National Institutes of Health (NIH) and our federal government allocate dollars for research in diseases and medical maladies. Right now, it seems that it’s all a political battle. If your guy or your gal is sitting at the right table at the right time and has the right pencil in their hand, then money flows to whatever disease or problem. That’s not the way we ought to be making decisions about where research dollars in this country go.

I believe it ought to be based on where we as a society can get the biggest bang for the buck. The resources that we have for research are finite, and so we need to spend them wisely. Trauma affects huge numbers of folks, and we do paltry little in terms of research and development in our country on the challenge of trauma. If we had an appropriate formula at NIH to determine where resources go so that scientists are charged with investigating the real challenges to the greatest number of folks in our country, then trauma would be way up there. But instead we do this in this political way.

AAOS Now: What about the recent push for comparative effectiveness research, particularly with regard to health care?

Dr. Price: The way comparative effectiveness is currently being used, written, and regulated is, by and large, done by nonmedical individuals looking at medical challenges and determining what is the most cost-effective treatment. That’s not the way decisions ought to be made.

We ought to have clinicians—people who are involved in caring for people, who know what it means and what it takes—defining the highest quality of care. I would have the specialty societies deciding what the quality of care is.

The federal government can’t look at every incident of care. It is ludicrous to believe that we ought to have a system that tracks whether this radiograph ordered for this patient was the right thing to do. We can use a Bell curve and track those individuals who are more than two standard deviations above or below the mean to see whether their practice model appropriately has them providing less care or more care than average. Are they taking care of sicker patients? Are they the tertiary referral center? Are they caring for the most challenged patients or are they gaming the system?

The specialty societies should be the robust repositories of information, of the direction of the clinical research that’s being done, and of the definition of clinical guidelines. They ought to be able to put in the affirmative defense for physicians in tort claims. Doctors need to know that the profession has agreed upon a method of practice and if they follow those principles of care, they won’t have to worry about being taken to court.

AAOS Now: Many AAOS members believe that the specialty societies aren’t being heard. They are asking, “Why isn’t orthopaedics as a specialty more effective politically? The Orthopaedic Political Action Committee (PAC) is strong and has support from more than a quarter of the fellowship…why aren’t our voices being heard?”

Dr. Price: I think the voices are being heard, but they’re not being followed. That speaks to the type of individual who needs to get into the political arena. That’s why I’m so proud of what Richard Blake Curd, MD did. As a fellow orthopaedist, he put things aside and offered himself for public service at the national level.

Physicians around the nation need to engage. We don’t all need to run for office, but we do need to find people who will be responsive to our message, and support those people in every way possible—contributing to campaigns, supporting the PAC. We need to spend some time every day between now and the election sharing our concerns and passion with our patients, our colleagues, and our neighbors.

The people of this country are mad because they don’t sense that their government is responsive to them or listening to them. The only way that will change is when people engage. Talk to different people every day and urge them to engage in the process. With the social media technology available to us, it really is relatively simple to do. But you must commit to doing it.

Don’t give up. The world of politics is a crazy world, and public policy has become much more political than it ever ought to be. But that doesn’t mean that you throw up your hands and give up. The folks who want things run differently—not by clinicians, not by physicians—they’re in the game, they’re in the battle, and so docs need to be as well.

Mary Ann Porucznik is managing editor of AAOS Now. She can be reached at porucznik@aaos.org

Editor’s note: While in Chicago to address the American Medical Association and the 8th Annual Orthopaedic, Spine and Pain Management-Driven Ambulatory Surgical Center Conference, Rep. Tom Price, MD, took some time to talk with AAOS Now managing editor Mary Ann Porucznik about healthcare reform, lawsuit abuse, and the upcoming elections.