Spine surgeons have been on their toes keeping up with new developments in healthcare policy in the first months of the year.
Here is how five surgeons are thinking about the landscape.
Note: Responses were lightly edited for clarity.
Question: How are you being proactive about federal policy shifts?
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: For federal policy shifts, especially with regards to tariffs and other increases in the cost of doing business, I think we just have to expect the unexpected. The current actions right now being taken by this administration, I don’t feel are very pro-small business. With tariffs, the cost of obtaining and maintaining goods is going to go up. I don’t feel that there’s any relief in sight for small businesses. It was also very disappointing to see physicians get their Medicare reimbursements cut again and Medicare Advantage plans that have been over billing the government and not providing care.
If you’re running a small business, especially a small medical business, I don’t feel that these things have been supportive. So in order to prepare, we really have to have cash and reserve to look for better deals in terms of expenses and costs. For instance things like cheaper internet, less expensive insurance coverage and less expensive physical spaces. And in some cases, we have to stop taking certain surgeries because it may be a net loss for some people. Ultimately, the patients will pay the price, and private practice people will pay the price as well. Until that has been rectified, I don’t see it getting any better.
Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): 1. CMS TEAM Model (Transforming Episode Accountability Model): A new mandatory bundled payment model from Medicare that will take effect in January 2026, covering 30-day surgical episodes (Lumbar fusions are included)
– Understand your cost drivers (enabling technologies, implant usage, various services, etc.) and participate in cost transparency initiatives.
– Develop standardized care pathways to improve predictability and reduce variability in 30-day episode costs. Evaluate necessary and unnecessary variability -> helps identify potential “waste”
– Advocate for inclusion of risk-adjustment tools to fairly capture complexity in spine patients, because not all lumbar fusions are the same!
2. Medicare Reimbursement Cuts: The CMS Physician Fee Schedule continues to introduce year-over-year cuts (or flat rates) for surgical procedures
– Find opportunities to better support and engage with advocacy groups that are lobbying Congress to halt physician payment cuts.
– Diversify revenue streams. Explore additional private payer and direct-contract options?
– Collaborate with hospitals or systems to share risk and negotiate better internal reimbursement models or incentive structures.
– Partner with private payers for value-based contracts that reward high-quality, cost-efficient spine care.
Lali Sekhon, MD, PhD. Spine Surgeon at Reno (Nev.) Orthopedic Center: I have no idea what is happening and things change on a daily basis. Sit tight and weather the storm.
Vladimir Sinkov, MD. Sinkov Spine. (Las Vegas): It is really difficult to predict the shifts in the federal government’s healthcare policy because it is often not based on logic, clinical science, or even financial reasons. It is mostly based on politics and lobbying efforts by the entities that control most of the money in the current healthcare system — health insurance companies, hospital systems, and pharmaceutical companies. Throughout my career I have not been able to find an effective way to be proactive about the federal policy shifts that would help my patients, my ability to treat them, or the financial stability of my practice. Most of the recent policies have been aimed at making it more difficult to stay in small or solo practice. It is not clear if these efforts are deliberate or accidental, but the effect is quite clear — fewer and fewer physicians are able to practice in a small group or solo private practice settings for financial and logistical reasons. The best way I found to be proactive regarding federal policy shifts is to structure my clinical practice to be as independent as possible from the federal government and its policies.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): The employed model is somewhat insular, yet not completely protective to the rapid federal shifts in State Medicaid funding and its impact on hospitals and patients. Our adherence to policies about surgical submissions/approvals and process will remain, but certainly expectant of additional scrutiny and oversight. Not exclusive to this community, many surgeons/facilities have opted out of the underinsured/uninsured patient populace, shifting this complex care to the larger, higher acuity facilities. These are currently well-established patterns of surgical practice in this country and most likely remain barring a universal care modeling institution.
