'Most tone-deaf move to date': Spine surgeons react to CMS' proposed 3.34% pay cut

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CMS on July 13 released its proposed 2024 Medicare physician fee schedule, and it includes a decreased conversion factor of 3.34 percent.

The news comes as a disappointment to many spine surgeons who are already facing reimbursement headwinds in recent years. 

Here is what six spine surgeons are saying about CMS' new move:

Note: Responses were lightly edited for clarity.

Chester Donnally, MD. Texas Spine Consultants (Dallas): I was definitely surprised to see that there would be a decrease in the Medicare payment fee schedule. This is a field of services where our supplies, services and, most importantly, staff have costs that continue to rise similar to this historic completion. Medical groups can't simply tell the patient to "pay more" because groups are essentially bound to the contracts set by insurance companies. 

One aspect I do support and was encouraged by was their request to have "continued coverage and payment of telehealth services included on the Medicare Telehealth Services List (as of March 15, 2020) until December 31, 2024." Telemedicine is very helpful to my patient population here locally! It's a very efficient follow-up for patients and their family. It's good to see some technology benefits embraced.

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: The recent reduction comes on the tail of another significant cut earlier this year. I think this highlights a couple of important facts about the current state of affairs of medicine. Firstly, the continued evaluation of physician services is obvious and will not stop. Next, it highlights the anti-physician bias of the bureaucracy of the Centers for Medicare Services. Third, it highlights the inaction and inability of physicians to organize effectively. Things could've always been worse, and for the sake of our advocacy groups fighting to stem the bleeding. But it's not enough. 

The bottom line here is physicians are going to have to form some form of collective bargaining organization if things are going to get better. Because as of right now, it looks as if CMS is creating some sort of a cage match between the large insurers to see who is going to run Medicare for all. 

Physicians are retiring and dropping insurance left and right, and they are trying to replace them with non-physicians that lack the training, expertise and judgment that are trained into positions from the first day of medical school to the last day of residency and during the entirety of their careers. Instead, they are settling and giving our patients and loved ones "shake and bake" care, which is not fair. People have paid into the Medicare system and their money is being wasted and given out as subsidies to these for-profit insurers who are now posting tens of billions if not hundreds of billions of money in profit.

I think the current administration and CMS are either intentionally or unintentionally heading us for the precipice. People are going to have to vote with their feet and tell their Congresspeople this has to stop. This latest cut represents perhaps the most tone-deaf move to date. In this current two-party system, it seems like neither party is taking this seriously. That is probably the most tragic thing, outside of patients paying more and losing access in the name of higher stock market trading prices. 

Ed Hellman, MD. OrthoIndy (Indianapolis): I think the Medicare reductions are shortsighted. Coming out of the pandemic orthopedic practices have been subjected to unprecedented increases in overhead. We've seen large numbers of licensed professionals, nurses, therapists, etc., leave their jobs. Wages for those who continue to work in their profession have gone up dramatically. At the same time the cost of supplies has increased at rates we haven't seen in the past. Now Medicare is cutting reimbursements by 3.34 percent. Some practices will have to consider limiting Medicare patient access in favor of higher paying patients. Others will consider this the last straw that pushes them to sell out to the local health system or to private equity. We know that as the health systems become more vertically integrated competition diminishes and costs to the entire system rise.

Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): This payment reduction is unfortunate but not surprising. CMS has been decreasing physician reimbursement for many years (while increasing hospital reimbursement every year). This will increase financial harships for independent medical practices, force more physicians to either reduce or stop accepting patients with medicare coverage and will ultimately reduce patient's access to care.

Karl Swann, MD. Spine Surgeon in San Antonio: Lawmakers on both sides of the aisle have forgotten that "you get what you pay for." Soon their constituents will receive such poor medical care that they will seek to replace the politicians who have presided over the decline. 

Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: Historically, reducing compensation has led to an increase in procedures. In an era when more than 50 percent of spine surgeries may be unnecessary, we are likely to see a further increase in volume of surgeries due to these measures. We need to think creatively on how to truly reward high-value surgeries and reduce unnecessary procedures — reducing physician compensation has never been and is not now the right solution.

Sadly, Medicare's strategy to slash prices has not worked to curb unnecessary care for the last 20 years. We need a different, more systematic approach. And we need to interrogate every problem, like the current epidemic of unnecessary surgery in this country, as well as potential solutions, before we introduce or change healthcare policies. If we don't, we risk unintended consequences. 

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