1. What do you think is the biggest challenge with the United States healthcare system - and if you were in charge, how would you address it?

Unfortunately the reimbursement rates for all specialties are decreasing yearly. This is leading to an alarming increase of specialized - and very skilled - physicians to drop out of insurance plans, and forcing patients to pay out-of-pocket for their service. The situation is even more dramatic if we consider Medicare and Medicaid. Regarding the former, I feel sorry for individuals who have paid their Medicare taxes for decades of their life, but now face difficulties finding someone that will take their insurance. All of my colleagues that have stopped taking Medicare wish they could continue to accept the plan, but unfortunately the reimbursement is so low that is does not allow them to cover the overhead costs.

Lower reimbursement rates also mean less research in new materials, new implants, and new instruments. In turn, this will translate into higher surgical revision rates, with ultimately higher costs for patients and insurance companies.

The only way to address this is for the government to immediately increase Medicare funding, and to force private insurance companies to restore adequate and reasonable reimbursement rates. Each insurance company should sit down with representatives from specialty professional associations to negotiate the numbers.


2. In your experience, what are the 3 biggest challenges you see people 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-plans that may or may not be accepted by physicians.

2.     High deductibles that are preventing people from seeking treatment, until their condition deteriorates so severely to require more complex (and costly) procedures.

3.     The internet. Too many patients seem to trust what they read on the web, instead of their physician. This creates much confusion in the patient’s head, leading them to seek multiple opinions (which can further confuse the patient), face greater costs, and waste (sometimes) precious time.


3. Please share an experience that you or an associate has had navigating the healthcare system that opened your eyes to a need for a better process or better information.

One patient came to my office for an urgent matter. When she called my office to make an appointment, she asked if I took a particular insurance plan, which I do. However, when the patient came to the appointment, we discovered that her particular insurance sub-plan was one of the few that I was not in network with. 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 forced her to pay cash, which also made me uncomfortable because I felt it was unfair.


4. Mr. Rogers once said, "look for the helpers." Which individuals, institutions, companies, or advocacy groups do you see playing a role in helping us navigate the complex and opaque US healthcare system?

My colleagues within the practice are my greatest resource. We are able to informally collaborate together to come up with the most effective and convenient plan for each patient. I am blessed to be surrounded by a group of truly caring men and women, who are also world-renowned orthopedic specialists.

I have recently discovered Better Health Advisors, which opened my eyes to a reality I had no idea existed. Insurance plans should really consider covering these services as, ultimately, they would actually lead to an overall lower cost of treatment.


5. The year is 2040: how will healthcare have changed? What will be the biggest innovation? Who will win, and who will lose, in this scenario?

Both doctors and patients will lose. Given the significant decrease in physician salaries, the brightest students will opt for non-medical careers, leading to the impoverishment of the entire healthcare system. Patients will have extreme difficulty getting specialized treatment unless they decide to pay very high out-of-pocket fees. The healthcare system will likely become purely private, with only life-threatening conditions being (almost) fully covered by insurance.


6. What single service, innovation or entity exists in United States healthcare that makes us the envy of the world? What would you point to as proof that our healthcare system may be flawed, but is still world class?

The access to cutting-edge technology is superior to many other Western countries. Research in the medical field is well funded by many private and public entities, allowing for rapid scientific growth that benefits the entire community. The highly selective training process allows only the brightest scholars to become physicians, contributing to a stimulating and productive scientific community. The international openness of the USA attracts talents regardless of nationality, ensuring that the most qualified individuals in the world chose the States as their new home. 


About Dr. Vulcano:

Dr. Vulcano is an orthopedic surgeon specializing in disorders of the foot and ankle as well as limb lengthening, deformity correction and percutaneous foot surgery.

Dr. Vulcano has diverse and extensive training. He graduated summa cum laude from Campus Biomedico University Medical School, the leading-ranked medical school in Rome Italy, and completed a rigorous orthopedic surgery residency at the University of Insubria in Varese, Italy, also graduating summa cum laude. 

He then completed a foot and ankle fellowship at the Institute for Foot and Ankle Reconstruction in Baltimore, MD, and an additional fellowship in limb lengthening, limb realignment, and complex reconstruction at the Hospital for Special Surgery in New York City, one of the only three centers for limb lengthening and reconstruction in the USA.

A recipient of national and international awards for excellence in clinical research, Dr. Vulcano has a strong research background in orthopedic surgery. He has co-authored several peer-reviewed publications and book chapters, and delivered presentations at national and international conferences.

Dr. Vulcano's unique combination of training allows for a comprehensive clinical evaluation and treatments tailored to each patient. Arthroscopic and minimally invasive surgery are employed whenever possible to shorten recovery time and decrease postoperative pain.