Medicare’s 2026 Physician Fee Schedule poses a headwind for spine surgeons, a reason Morgan Lorio, MD, said his focus in the new year will be on physician advocacy.
Dr. Lorio, past president of the International Society for the Advancement of Spine Surgery and chair emeritus of ISASS’ coding and reimbursement task force, discussed his top priorities in the year ahead.
Note: This response was lightly edited.
Question: What is your top priority in 2026? Why?
Dr. Morgan Lorio: My top priority for 2026 is to defend and restore fair valuation for spine surgery within Medicare’s Physician Fee Schedule especially as CMS imposes an unjustified 2.5% “efficiency adjustment” to the work RVUs of non-time-based procedures.
This policy shift breaks from the longstanding RUC formula of work = time × intensity, substituting actuarial assumption for clinical reality. For spine surgeons, whose operative times are growing longer and more complex due to aging patients and minimally invasive innovations, this so-called “efficiency gain” is neither observed nor evidence-based. It represents a silent erosion of value, devaluing skilled work without regard for patient acuity, intraoperative decision-making or postoperative burden.
CMS’ continued movement toward claims-derived surgical times, the redirection of indirect practice expense payments away from OR-based specialties, and the persistent failure to address the Medicare Economic Index gap all reflect a troubling trend: a structural shift away from procedural medicine.
In response, I am focused on three interlinked goals:
1. Preserve the Time × Intensity Framework: The statutory bedrock of surgical valuation must be protected from assumption-driven shortcuts.
2. Push for Specialty-Specific Representation: Operative durations in spine surgery are highly variable and complexity-driven. Any recalibration of times must include specialty input to avoid misrepresentation.
3. Reform Medicare Advantage Prior Authorization: Coverage parity and binding predetermination are essential. The status quo of retroactive denial and administrative drag continues to harm patients and surgeons alike.
The cost of inaction is high. As the real value of surgical work is chipped away through RVU deflation, inflation ignorance, and administrative overreach, we risk driving the next generation of surgeons away from procedural specialties. We must advocate not just for dollars, but for the dignity of surgical labor and the patients it serves.
