These CMS changes would significantly improve spine care: 6 surgeons weigh in


From revamping codes to reversing prior authorization requirements and increasing reimbursement, six spine surgeons discuss CMS changes that would enhance spine care.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

Next week's question: How do you see motion-preservation technology developing in spine?

Please send responses to Alan Condon at by 5 p.m. CST Wednesday, Feb. 24.

Note: The following responses were lightly edited for style and clarity.

Question: What's one change CMS should implement that would greatly benefit spine care?

Michael Gordon, MD. Hoag Orthopedic Institute (Orange County, Calif.): If the benefit is for surgeons, I would say payment should be risk-adjusted and site of care should be irrelevant so surgeons are paid properly for risk and expertise and to avoid gaming the system on where to do surgery and how long to keep patients in the hospital.

1. [CMS] needs to pay more — spine surgeons have seen a steady decline in reimbursement.

2. Coding for outpatient anterior/posterior lumbar fusion is not up to date.

3. The bundled payment system is not good for spine. It needs modification.

If the benefit is for patients, I would create accessible, transparent, risk-adjusted outcomes data on each surgeon and facility so they can compare apples to apples when choosing.

Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): CPT modifier 22. As all are aware, this code is frequently indicated, but rarely honored by CMS reimbursements. The duplicative dictations and submissions of patient descriptors, complexity and additional time allotments are usually not enough to 'qualify' certain individuals for applied reimbursements. Especially in a patient populace that carries more acuity, risk and complication rates. Our anesthesia colleagues no longer submit with the supplemental application process of the modifier 22, even in inarguable cases with the highest [American Society of Anesthesiology] scores or body habitus. Their record of recovery of the modifier from CMS is so low.

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: There needs to be two things. CMS has to suspend budget neutrality in order to not gut reimbursements for spine surgeons and their supporting physicians. CMS also has to not have such a paternal/maternal-istic view of knowing what's best. What we have seen with [the last] administration is a dismissive attitude that did not help matters. We hope that CMS will be a better partner in making sure patients get the care they need.

Issada Thongtrangan, MD. Microspine (Phoenix): The only hope I have is that the CMS will not keep trimming the professional fee. As we all know, advanced technology is not without cost, but it is for the patients' outcomes. It is sad to see that CMS looks at the surgical technique as one-all-be-all. For example, the open lumbar fusion is not equal to minimally invasive fusion or endoscopic fusion in terms of the work and instruments each surgeon uses.

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): Spine surgery outcomes have gotten significantly better in recent years, especially with the introduction of such innovations as minimally invasive spine surgery, disc replacement, and navigated and robotic surgery. Despite that, CMS reimbursement per procedure has been going down every year for as long as I can remember. Spine care would greatly benefit if CMS can start paying spine surgeons appropriately (commensurate with increasing practice costs, inflation and increasing regulatory burdens) for the work done. In my 11-year career in spine surgery I have seen my Medicare reimbursement for most spine operations decrease every year, even though I can now do them better with better patient outcomes. I am not aware of any other industry where a professional gets paid less for doing the same work as their experience and quality of work improves over the years.

Richard Chua, MD, Northwest NeuroSpecialists (Tucson, Ariz.): Reverse the decision made last year to require prior authorizations for imaging and surgeries, including outpatient surgeries.

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