The regulatory changes spine surgeons want most

Anuja Vaidya -   Print  | Email

Two spine surgeons discuss the regulatory changes that could improve spine practice.

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: Would a single-payer insurance system help or harm spine practice?

Please send responses to Anuja Vaidya at by Wednesday, June 5, 5 p.m. CST.

Question: What is the next major regulatory change you would like to see in the spine field?

Christian Zimmerman, MD. Spinal Neurosurgeon at Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): The current climate of insurance denials and appeals would certainly benefit from a dose of reciprocal oversight and scrutiny. Granted, the numbers of spinal surgeries have been controlled of late, but the circumstances and reasonability for approvals seem arbitrary at times. Most communities are aware of 'unsafe' spinal surgery practices through outcome data and intraoperative procedural carelessness. These few require the oversight imposed, but the one-size-fits-all model is neither complementary to surgeon nor patient.

Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: Most regulatory changes coming down the pike are related to payers and out-of-network 'surprise' billing. What I would like to see, and what most of the societies are lobbying for, is a fair and equitable solution. There are forces pushing for all doctors to be paid as if they are in-network. We are pushing back against this, as the entities that would determine that rate are, of course, the same exact ones that caused the very issues we are trying to fix.

As professionals, we are hoping to see legislation pass that will help doctors stay in business. If a bill that would force doctors to take in-network rates passes, without question two things would happen: Those rates will go down, and more doctors would become employed. In effect, the insurers lobbying for doctors to take their already inadequate rates will end up driving their own costs up again. Maybe instead of thinking of quarterly profits, the payers should consider a more longitudinal strategy and pay so that they can ultimately survive past 2020.


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