1. What do you think is the biggest challenge with the UnitedStates healthcare system - and if you were in charge, how would you address it?
Unfortunatelythe reimbursement rates for all specialties are decreasing yearly. This isleading to an alarming increase of specialized - and very skilled - physiciansto drop out of insurance plans, and forcing patients to pay out-of-pocket fortheir service. The situation is even more dramatic if we consider Medicare andMedicaid. Regarding the former, I feel sorry for individuals who have paidtheir Medicare taxes for decades of their life, but now face difficultiesfinding someone that will take their insurance. All of my colleagues that havestopped taking Medicare wish they could continue to accept the plan, butunfortunately the reimbursement is so low that is does not allow them to coverthe overhead costs.
Lowerreimbursement rates also mean less research in new materials, new implants, andnew instruments. In turn, this will translate into higher surgical revisionrates, with ultimately higher costs for patients and insurance companies.
Theonly way to address this is for the government to immediately increase Medicarefunding, and to force private insurance companies to restore adequate andreasonable reimbursement rates. Each insurance company should sit down withrepresentatives from specialty professional associations to negotiate thenumbers.
2. In your experience, what are the 3 biggest challenges you seepeople face when seeking healthcare or navigating the healthcare system?
1. Understanding which doctor takes which insurance plan.Many patients don’t know that within each insurance plan is numerous sub-plansthat may or may not be accepted by physicians.
2. High deductibles that are preventing people from seekingtreatment, until their condition deteriorates so severely to require morecomplex (and costly) procedures.
3. The internet. Too many patients seem to trust what theyread on the web, instead of their physician. This creates much confusion in thepatient’s head, leading them to seek multiple opinions (which can furtherconfuse the patient), face greater costs, and waste (sometimes) precious time.
3. Please share an experience that you or an associate has hadnavigating the healthcare system that opened your eyes to a need for a betterprocess or better information.
Onepatient came to my office for an urgent matter. When she called my office tomake an appointment, she asked if I took a particular insurance plan, which Ido. However, when the patient came to the appointment, we discovered that herparticular insurance sub-plan was one of the few that I was not in networkwith. Since the patient was not willing to wait to have her condition treated,she decided to pay out-of-pocket. The urgency of her condition basically forcedher to pay cash, which also made me uncomfortable because I felt it was unfair.
4. Mr. Rogers once said, "look for the helpers." Whichindividuals, institutions, companies, or advocacy groups do you see playing arole in helping us navigate the complex and opaque US healthcare system?
Mycolleagues within the practice are my greatest resource. We are able toinformally collaborate together to come up with the most effective andconvenient plan for each patient. I am blessed to be surrounded by a group oftruly caring men and women, who are also world-renowned orthopedic specialists.
Ihave recently discovered Better Health Advisors, which opened my eyes to areality I had no idea existed. Insurance plans should really consider coveringthese services as, ultimately, they would actually lead to an overall lowercost of treatment.
5. The year is 2040: how will healthcare have changed? What willbe the biggest innovation? Who will win, and who will lose, in this scenario?
Bothdoctors and patients will lose. Given the significant decrease in physiciansalaries, the brightest students will opt for non-medical careers, leading tothe impoverishment of the entire healthcare system. Patients will have extremedifficulty getting specialized treatment unless they decide to pay very highout-of-pocket fees. The healthcare system will likely become purely private,with only life-threatening conditions being (almost) fully covered byinsurance.
6. What single service, innovation or entity exists in UnitedStates healthcare that makes us the envy of the world? What would you point toas proof that our healthcare system may be flawed, but is still world class?
Theaccess to cutting-edge technology is superior to many other Western countries.Research in the medical field is well funded by many private and publicentities, allowing for rapid scientific growth that benefits the entirecommunity. The highly selective training process allows only the brightestscholars to become physicians, contributing to a stimulating and productivescientific community. The international openness of the USA attracts talentsregardless of nationality, ensuring that the most qualified individuals in theworld chose the States as their new home.
About Dr. Vulcano:
Dr.Vulcano is an orthopedic surgeon specializing in disorders of the foot andankle as well as limb lengthening, deformity correction and percutaneous footsurgery.
Dr.Vulcano has diverse and extensive training. He graduated summa cum laude fromCampus Biomedico University Medical School, the leading-ranked medical schoolin Rome Italy, and completed a rigorous orthopedic surgery residency atthe University of Insubria in Varese, Italy, also graduating summa cum laude.
Hethen completed a foot and ankle fellowship at the Institute for Foot and AnkleReconstruction in Baltimore, MD, and an additional fellowship in limblengthening, limb realignment, and complex reconstruction at the Hospital forSpecial Surgery in New York City, one of the only three centers for limblengthening and reconstruction in the USA.
Arecipient of national and international awards for excellence in clinicalresearch, Dr. Vulcano has a strong research background in orthopedic surgery.He has co-authored several peer-reviewed publications and book chapters, anddelivered presentations at national and international conferences.
Dr.Vulcano's unique combination of training allows for a comprehensive clinicalevaluation and treatments tailored to each patient. Arthroscopic and minimallyinvasive surgery are employed whenever possible to shorten recovery time anddecrease postoperative pain.
http://www.mountsinai.org/profiles/ettore-vulcano
