'The exact opposite of what needs to be done' — 6 surgeons on CMS' proposed 2021 fee schedule


CMS' Medicare Physician Fee Schedule proposed rule for 2021, announced Aug. 3, laid out significant cuts for surgeons in several specialties.

The American Academy of Orthopaedic Surgeons, American Association of Neurological Surgeons and Congress of Neurological Surgeons are among the professional societies that have voiced their opposition to the rule.

Here, three spine surgeons and three orthopedic surgeons outlined what the cuts would mean for their practice, Medicare beneficiaries and the wider surgical field.

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: The idea of these deep cuts to reimbursement neither surprise nor aggravate me. I think as a grateful recipient of the Coronavirus Aid, Relief, and Economic Security Act, myself and other physicians should have known what the "strings" were going to be. By cutting our reimbursements, it makes it less and less likely for physicians to be able to remain independent. If you couple this, with increasing the number of nurse practitioners and physician assistants being able to practice independently, you are cooking up a recipe for a slow-motion implosion of our current system, without a plan. You will see from the latest financials from the top four insurance companies that they are posting record profits. Not to mention now the second major insurer has been charged in a whistleblower suit for defrauding CMS of millions. So we, as physicians, are not sure why we are at the sharp end of these changes. At the end of the day, the cuts just speed up the tremendous explosion of cost that will be taxing the system and doing precisely the exact opposite of what needs to be done.

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): CMS proposes to decrease the conversion factor that guides reimbursement for surgery by approximately 10 percent. Basically, this will lead to surgeons being reimbursed 10 percent less to do the same surgery in 2021 as they did in 2020. In the meantime, the price of medical education, the cost of rent, the cost of business and malpractice insurance, staff salaries and overall cost of living will increase in 2021 as they have done every year. Such a devastating cut in reimbursement will have terrible financial consequences to all surgical practices, which have already been hit very hard by the pandemic and restrictions on elective cases.  

If implemented, such cuts will result in lower revenue for private surgical practices. Medical practices will have a harder time hiring more employees or investing in better technology. Some practices will adjust by seeing fewer Medicare beneficiaries or opting out of Medicare altogether. The end result will be worse access to care, longer wait times and potentially a decrease in quality of care to one of the most vulnerable populations — Medicare beneficiaries. Delays in care will lead to more complications and permanent issues that will, in the long term, cost Medicare more and will negate any financial savings that CMS is planning on through such cuts. I hope they realize it before it is too late. There was a similar issue several years ago, where an approximately 20 percent Medicare reimbursement cut was looming, but was averted at the last moment through bipartisan legislation.  

Ann Stroink, MD. Central Illinois Neuro Health Sciences (Bloomington): Now is not the time to reduce payments for surgical care, and if implemented as is, the Medicare payment rule will challenge an already fragile health care system ... This was an ill-informed and dangerous policy for patients even before the pandemic started, but could be even more detrimental as our healthcare system continues to weaken under COVID-19. If finalized, this proposal could result in neurosurgeons taking fewer Medicare patients leading to longer wait times and reduced access to care for older Americans, so Congress must act now to prevent this from happening.

Joseph Bosco, MD. NYU Langone Health (New York City): The AAOS is extremely disappointed in CMS' decision to disregard our petitioning, many discussions and data presented against these cuts. Devaluing the time and effort that orthopaedic surgeons spend prioritizing value-based care communicates a larger plan by the agency to gradually reduce the value of these procedures. Not to mention the fact that our surgeons have the highest participation rates across medical subspecialties in alternative payment models, where they work to optimize care and improve patient outcomes all while reducing costs.

Worsening the financial strain on these practices, at a time when they have been disproportionately affected by COVID-19 federal guidelines to delay care, will have a severe and lasting impact on American seniors' access to these life-improving surgeries. According to an AAOS survey conducted earlier this year, 34 percent of patients had postponed surgeries by more than three months in response to the COVID-19 crisis.

The AAOS urges CMS to reconsider the significant preoperative work that is required to make value-based care both cost-effective and high-quality, and to refrain from finalizing both of these punitive cuts on the value of orthopaedic care.

Lowry Barnes, MD, UAMS Health (Little Rock, Ark.): If these Medicare cuts are finalized, it sends a strong signal: when providers in the vanguard of value-based care begin to achieve some efficiencies in the delivery of care, CMS will use those positive developments as a justification to cut Medicare fee-for-service reimbursement regardless of the extra work that goes into achieving these outcomes.

James Huddleston III, MD. Stanford Health Care (Palo Alto, Calif.): The American Association of Hip and Knee Surgeons is deeply disappointed that the American Medical Association Relative Value Scale Update Committee and CMS, despite our extensive advocacy efforts over the last 21 months, chose not to give us credit for the pre-optimization work that they acknowledged is being done by our surgeons. We will continue to work with them to facilitate a mechanism by which this critically-important work can be incorporated into their methodologies.

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