'Sad but not surprising': Spine, orthopedic surgeons react to the CMS 2023 proposal

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Many spine and orthopedic surgeons were disappointed by the proposed 2023 rules from CMS. One of the major proposed changes is a decrease in the Medicare Physician Fee Schedule.

Below, three surgeons react to the proposal.

Note: Responses were edited for clarity.

Question: What are your first impressions of the 2023 CMS proposal? What changes do you hope to see?

David Kalainov, MD. Northwestern Medicine (Chicago): The proposed decrease in the Medicare Physician Fee Schedule for 2023 (i.e. the relative value unit conversion factor) will very likely have an adverse impact on timely access to care for nonemergent orthopedic conditions in the Medicare insured population (approximately 60 million people), at least in the near term. Issues surrounding the proposed decrease are analogous to the problems encountered with the sustainable growth rate that led to annual emergency congressional funding of CMS payment cliffs. Understandably, there are numerous pieces to this economic puzzle (an aging population, a projected end date for the Medicare Part A Trust Fund, healthcare consolidation/integration, changing value-based care models, expensive tests and treatments and patient and clinician expectations). I support the voices of leaders in our medical and surgical societies to avoid a decrease in the Medicare conversion factor. The Medicare Access and CHIP Reauthorization Act of 2015 may need an overhaul.

Issada Thongtrangan, MD. Microspine (Scottsdale, Ariz.): It is sad but not surprising. Our government is planning to reduce payments to physicians by 5 percent for taking care of patients with Medicare. This is in the midst of the worst inflation in the past 20 years, so the effect will be more than 5 percent on paper. Physicians already lose financially when they take care of Medicare patients, especially if they are not healthy, and more and more physicians opt out of taking care of these patients. What do you think will happen to healthcare for Medicare patients in the future if this trend continues? Providing quality care will be more challenged in this environment and sadly nothing we can do about it.

Brian Larkin, MD. Orthopedic Centers of Colorado (Denver): CMS’ recently published proposal to cut the conversion factor to $33.08 in calendar year 2023, as compared to $34.61 in CY 2022, is an unfortunate update. This decrease in the conversion factor is secondary to the expiration of the 3 percent statutory payment increase, and a zero percent conversion factor update, required in the setting of budget neutrality. At a time when healthcare continues to feel the long-lasting impacts of the COVID-19 pandemic, current economic rates of inflation and increased wage requirements from a burnt out work force, balancing the budget on the backs of the providers seems inappropriate.

From a provider perspective, the current Medicare Physician Fee Schedule seems to be broken. Providers were faced with a 9.75 percent cut on Jan. 1, 2022, which was pushed off with last-minute congressional action. Medicare sequestration cuts of 1 percent went into place on April 1, 2022, and 2 percent on July 1, 2022. The constant downward pressure on Medicare reimbursement forces physicians to consider whether participation in Medicare is a financially viable solution. Ultimately, this will lead to lack of patient access to providers that participate in Medicare.

There is no question that the costs of healthcare in the U.S. continue to need to be addressed, but relying on physician payment reductions seems like a poor lever. This method fails the patient, does not allow for collaboration and does not reward efficient, high-quality care. Lastly, the constant shuffling of these rates does not allow providers to adequately plan for or adapt to changes that occur. I believe we need to evolve the Medicare Fee Payment schedule to one that helps incentivize and reward behavior that provides high-quality, cost-efficient care.


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