The changes spine surgeons are advocating for in healthcare today


From fighting to maintain access to innovative technologies to pushing back against reimbursement cuts and increasing payer hurdles, the concerns of spine surgeons are many.

Five spine surgeons discuss the importance of advocacy at the state and federal levels and what changes they are pushing for in healthcare today.

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. Becker's invites all spine surgeon and specialist responses.

Next week's question: What will be the next big advancement in complex spine surgery? 

Please send responses to Alan Condon at by 5 p.m. CDT Wednesday, Oct. 20.

Editor's note: The following responses were lightly edited for style and clarity.

Question: When it comes to advocacy, what are the most topical areas for spine surgeons today? 

Philip Schneider, MD. The Centers for Advanced Orthopaedics (Bethesda, Md.): In my opinion, the biggest issue impacting spine surgeons right now is the 2022 Medicare Physician Fee Schedule, which would considerably reduce Medicare reimbursements. I am president of the National Association of Spine Surgeons, the leading advisory group for spine care, and we are working to reverse these potential cuts that would be devastating to patients and would affect access to care. Should this get passed, physicians would not be able to treat as many Medicare patients simply because they could not afford to. Another issue we’re focusing on is Bill HR3137: Improving Seniors Timely Access to Care Act, which would streamline the current prior authorization process for scheduling surgeries and improve access to care.

At The Centers for Advanced Orthopaedics, we are utilizing telehealth for services where it makes sense, and patients have come to appreciate the convenient, quality care. When the public health emergency expires, however, telehealth will no longer be covered by Medicare, which is something we will advocate to change.

Ali H. Mesiwala, MD. DISC Sports & Spine Center (Newport Beach, Calif.): As healthcare rapidly evolves, spine surgeons need to be at the forefront of advocating for policy changes that maintain patients' access to emerging technologies, techniques and care. Restrictions imposed by insurance companies and other payers can make access to care very difficult and lead to poor outcomes. Historically, spine surgeons have focused more on the clinical aspect of medicine and left advocacy to politicians and lobbyists. Similarly, a lack of understanding of coding and procedural terminologies and requirements has created financial problems for many surgeons and led to missed opportunities. 

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: As a member of two political action committees and my involvement in my state-level organization, the necessity for physicians to be advocates is especially important to me. The learned helplessness of your average spine surgeon is very distressing. I was recently at a meeting where some fascinating data on machine learning and predictive modeling was being showcased. The surgeon creating this model was using it to get insurers to pay attention to their data analytics in the hope of showing how good surgeons can be, given the right kind of patient and surgery and so forth. There is the concern that this would effectively remove the surgeon and patient from the decision process. That aside, this was all well and good, except what was not taken into account is how data like this can be weaponized and used as an argument against doing any surgery, or that a surgeon should not get paid unless their outcome is exactly as the algorithm predicted.

So the mindset of surgeons must be two-pronged: 1) No one cares about our patients but us; 2) no one will fight for us but us. Surgeons need to be quick to involve their Congress people in disputes with insurers. If anything, we need to be less cooperative with the very entities that seek to erode the relationship we have with our patients. Innovative data analytics and pattern analysis and predictive models need to be developed in a very careful and thoughtful manner; an innovative surgeon's hard work can easily be perverted to hurt patients and surgeons. We need to stop fighting for pyrrhic victories and start winning up front. Finally, if we are going to fight for ourselves and our patients, we cannot fight amongst ourselves. Those of us in the upper echelons of organizations that create value units or remuneration models cannot and should not seek to shoot ourselves in the collective foot. It is only by realizing our own power and our own duty to protect our patients and our specialty, can we push back and stop accommodating the erosion of our art.

Nitin Bhatia, MD. UCI Health (Orange, Calif.): Spine surgeons must continue to be vocal advocates for our patients. As payers decrease access to care via limited provider networks, increased roadblocks such as "peer-to-peer" reviews for even basic imaging studies, and decreased physician reimbursement, patients may be limited with regard to which physicians and procedures are available to them. Spine surgeons must continue to advocate for evidence-based medicine with reasonable access and reimbursement.  

John Dickerson, MD. Kansas Spine & Specialty Hospital (Wichita): Our goal first and foremost is to advocate for our patients and to uphold their best interests. Sometimes that means going to bat for them with the insurance company, and other times it means redirecting their own views about the best treatment for them. Ultimately, our job is to educate and work with the patient to provide the best care for that patient.

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