Thomas Loftus, MD, founded the Austin (Texas) Neurological Institute in 2003. He treats a wide range of neurological disorders with a special focus on complex spine and minimally invasive techniques.
Here, Dr. Loftus discusses how a single-payer system would affect spine practice in the U.S. and the biggest obstacles facing spine surgeons today.
Question: Would a single-payer system help or harm spine practice?
Dr. Thomas Loftus: Based on single-payer systems that exist in markets in other countries, it seems that single-payer insurance would hurt spine practice. To allow absolute control of healthcare delivery by a single payer restricts patient access to care and severely affects and limits decision making by the actual physician. The small advantage of not having to deal with multiple insurance companies would be greatly offset by the complete disruption of who makes the actual healthcare decisions. It would be bad for patients and bad for their physicians.
Q: What do you think is the biggest obstacle facing spine providers today?
TL: Insurance denials for arbitrary and inconsistent reasons continue to be the biggest hurdle in spine practice. As surgeons, it is important to continue to fight on behalf of our patients so that these denials don't become accepted practice and prevent our patients from having access to treatments that they need.
Q: What is the next major regulatory change you would like to see in the spine field?
TL: There seem to be spine device companies now that exist solely to push spine implant placement procedures to nonsurgical specialists. There are significant concerns regarding nonsurgical specialists who are beginning to perform actual spine surgeries. They have no formal neurosurgical or orthopedic spine training and are now inserting spine implants into patients. It seems that there is no real regulatory oversight on the actions of these device companies. Given all the burdensome and unnecessary regulations that do exist in medicine, it is surprising that nobody in the federal, insurance, or hospital-based regulatory systems is paying any attention to these companies, their questionable practices and poorly delineated indications for their implant usage. I would like to see more regulatory scrutiny of these device companies.
Q: Where do you see the biggest need for advancement in spine patient care?
TL: As always, we need to continue to push for more outcome-based literature. As clinicians, we can anecdotally see the improvements in our patients as we provide care, but it will always be in our best interest to provide objective, meaningful studies to support our treatment protocols. As there is more pressure from payers to cut costs, we need to produce the data that advances the cause of what we do to help patients.
Q: What is your opinion of how the healthcare industry is covered in the media?
TL: Unfortunately, the media is driven by pushing stories that sell, rather than stories that inform. Like so many industries, healthcare is an unfortunate victim of that practice. Most media coverage seems to push a narrative rather than provide a balanced assessment of healthcare industry issues. Whether reporting on the purported opioid crisis, vaccination concerns, or healthcare fraud investigations, it is difficult to find media coverage that is balanced and informed. It creates a lot of unnecessary confusion and often negative consequences for patients and their physicians. Many of the issues are too complex to be fairly reported in the current media formats.