Why payers need to see the value in collaborating with surgeons


Orthopedic and spine surgeons are feeling a growing disconnect between themselves and payers. As physician demand from payers is increasing, reimbursement rates nationwide are declining. 

The best way to fix some of these issues is for payers and surgeons to begin collaborating and participating in open discussions with one another to understand problems and identify solutions, according to two physicians. 

Question: What do payers need to change for orthopedic and spine surgeons in 2023? 

Adam Bruggeman, MD. Texas Spine Care Center (San Antonio): I certainly hope payers see the value in collaborating with physicians over the next year. It seems that we are constantly at odds with each other, and yet the decisions being made by carriers, such as increasing prior authorization burdens and ratcheting down fee-for-service payments, have actually increased the cost of care through delayed treatment and consolidations in the market.  

Kornelis Poelstra, MD, PhD. Allegiant Spine Institute (Las Vegas): For the remainder of this year, I hope payers will realize that we have a consistently unsustainable growth rate of demands on physicians, while reimbursement, especially in spine, is continuously trending down. Great quality care that is fiduciary responsibility can only be provided if surgeons are aligned with the payers, and the ever increasing cleft between the two of us is harmful for patient access.

We need to have a constructive discussion to continue to allow patients access to the highest level of care that is appropriate for their condition, and that can only be ensured if there is a reduction in unnecessary paperwork, authorizations and pre-approval phone calls that are continuously coming our way.

This reduces our ability to focus on what is really difficult and important, and that is cost-effective care provision of the greatest quality without the ever increasing administrative burdens that distract us from executing our true profession. 


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