Dr. Robert Brady: How the 2020 CMS final rule will affect the spine field

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CMS removed six spinal procedures from the inpatient-only list in the CY 2020 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule, issued Nov. 1.

The changes take effect Jan. 1, 2020, and mean Medicare will reimburse for the procedures in both the hospital outpatient and inpatient settings.

Robert Brady, MD, an orthopedic surgeon and spine specialist at Norwalk (Conn.) Hospital and part of Danbury-based OrthoConnecticut, discusses how the incoming CMS final rule will impact the field.

Note: Responses are lightly edited for style and clarity.

Question: How do you expect the incoming CMS final rule to affect the spine field come Jan. 1?

Dr. Robert Brady: CMS rule changes have typically been aimed at lowering the costs of healthcare. I believe this upcoming rule change will accomplish two goals. The first is to further encourage the transition of hospital-based surgical procedures toward outpatient surgical centers. It is well known that surgical centers can perform most all procedures at a lower cost and typically with greater efficiency. The second consequence is that the new rule will make it easier for payers to deny inpatient admission costs and put a greater burden on physicians and surgeons to justify and meet inpatient criteria.

Q: What has been the most challenging part of your practice this year? What strategies or initiatives are you planning on implementing in 2020?

RB: It has always been my philosophy to practice evidence-based medicine. This has been particularly relevant regarding the procedures I offer my patients. Robotic navigation for placement of pedicle screws has become a major part of my practice over the last year and a half. The robot has allowed me to become more efficient and more accurate, with less intraoperative radiation, making it safer for the patient, staff and me. I am currently working on projects to expand the utility of robotic navigation to a greater portion of my procedures such as interbody insertion.

Q: What is the next major regulatory change you would like to see in healthcare?

RB: I am a big proponent of empowering physicians with the ability to institute the necessary diagnostic tools and treatment protocols to provide optimal patient care. With that being said, I don't believe more regulations will achieve that goal. With the practice of evidence-based medicine, physicians need to be trusted with the ability to self-regulate and take the control out of the powerful insurance company lobbyist.

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