Spine surgeons: CMS should reward physicians focusing on cost-effective, quality care


Spine surgeons have criticized Medicare's proposed rules for 2023, which would further reduce physicians' professional fees and reimbursement for procedures performed. 

Five spine surgeons shared their thoughts on the current state of Medicare and what changes could improve spine care, including an overhaul of the bundled payment systems, risk-adjusted payments to eradicate site-of-care challenges and increased pay for surgeons demonstrating superior quality and cost-effective care.

Note: Responses were lightly edited for length and clarity. 

Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): Enormous losses in the first half of 2022 are being widely published over the past couple of weeks. Our healthcare system is heavily burdened by short staffing, burnout and hospital capacity concerns, many of which are pandemic related. Oh, and by the way, we are still living in the pandemic. Unfortunately, these stressors are compounded by pressures to achieve financial and volume targets amid historical inflation rates. 

The proposed decrease in the Medicare Physician Fee Schedule for 2023 may have negative consequences that will force providers to shoulder some of this financial burden and potentially limit critical access for Medicare patients, potentially marginalizing a population that is currently being further marginalized by larger macroeconomic forces. The Medicare Fee Payment Schedule needs to focus on targets around quality and cost-effective care, rewarding those focused on these results.

Michael Gordon, MD. Hoag Orthopedic Institute (Orange County, Calif.): 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 surgery. 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.

Morgan Lorio, MD. Advanced Orthopedics (Altamonte Springs, Fla.): CMS needs to accept the RVS Update Committee's recommendations as presented to them. These procedure values should be published as proposed in the Proposed Rule. CMS should consider data presented to them from interested parties and key stakeholders during the comment period and then make final rule decisions based on critical information collected during this time.

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.

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.

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