'Patients will and do suffer': 5 spine surgeon reactions to CMS' 4.48% physician fee cut

Spine

CMS recently published its final rules for 2023, which include a 4.48 percent decrease in physician fees, a move worrying many spine surgeons.

Here is what five spine surgeons told Becker's about the rule and how it will affect the specialty.

Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): Our healthcare system is struggling on several fronts right now, and the financial losses have compounded the situation. We have seen several large hospital systems shut down service lines and other smaller medical centers close their doors. On top of that, we are faced with a system that is also heavily burdened by short staffing, burnout and hospital capacity concerns as we claw out of a pandemic.

I fear that Medicare's 4.48 percent physician fee cut may have negative consequences that will force providers to shoulder some of this financial burden. Sure, I get it, people generally aren't going to feel sorry for the physicians here, but these cuts could also potentially limit critical access for Medicare patients, thus marginalizing a population that is currently being further marginalized by larger macroeconomic forces. Additionally, we have spent the past few years building value-based care pathways, developing quality-based programs and academic pursuits to innovate — and these programs may have to take a back seat in order to provide the greatest volume of care to "catch up" financially with these additional cuts.

Ultimately, I think CMS needs to focus on targets around quality and cost-effective care, rewarding those focused on these results, rather than institute broad widespread fee cuts.

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): The CMS' final rule with 4.48 percent cut to physician reimbursement will put additional financial pressure on physicians, especially the ones in private practice. Combined with the current historically high inflation rate and increasing staff salaries, this rule will make it even less financially sustainable for physicians to continue treating patients with Medicare coverage. This will inevitably lead more physicians to either decrease the amount of Medicare patients they see or to opt out of Medicare altogether. Medicare recipients will have a harder time getting access to timely care. Delays in care will result in greater medical morbidity, disability and higher costs at the end, so this cut will only increase overall healthcare expenditures and result in worse healthcare outcomes for Medicare recipients.   

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: I think a nearly 5 percent cut along with the continued sequestration (which adds up to 8 percent or more) in Medicare payments to cause a significant reduction in the number of physicians taking on new Medicare patients as well as dropping Medicare altogether. The myopic actions of both CMS and HHS is astounding even to the most seasoned of people in the healthcare policy space. We have seen record profits for insurance companies topping over $5 billion a quarter while they turn around and tell the government that they require more subsidies to take care of sick patients yet they themselves are paying out less and less. The phenomenon of corporate welfare is now fully in effect in our healthcare system.

Patients will and do suffer, ultimately as more and more physicians will stop taking Medicare and therefore stop seeing Medicare patients. Some physicians will continue to see Medicare patients put on a fee-for-service schedule, as it is their right to do so. Some Medicare patients will try to scrape together some dollars and see their doctors. Others will opt for in-network physicians and wait, or travel long distances. The bottom line is that these people have worked very hard to save their Medicare dollars and have deductions taken from their paychecks on a biweekly basis so they do not have to worry about how to pay for their healthcare. 

Medicare was originally designed to help low-income folks afford healthcare. For better or for worse, it has morphed into a form of universal coverage. People depend on it. It is not fair that the Medicare trust is being squandered on corporate profit takers. Ultimately, the voting public will need to decide and speak to their people in Congress, because as it is going right now, the future is not so bright. 

As the ostensibly for-profit insurance companies bleed the Medicare trust dry and cry out for more subsidies to the tune of billions, the siloed bureaucracy of CMS operates without accountability or consequence. Physicians also need to push back — file FOIA requests and ask their representatives why physician remuneration, which accounts for about 7 percent of our total healthcare spend, is being targeted rather than the giant payouts insurance companies receive, who then refuse to pay for services rendered.  

It's also interesting as demonstrated in several peer reviewed articles that while Medicare (and therefore any fee schedules that follow it) goes down, and with no COLA since its inception, why are costs still going up? It's clear that the right voices do not have agency in the healthcare space. Granted, fees are high, and I think physicians welcome an honest conversation on what things should cost. It asks any patient if they think the cost of a craniotomy should cost less than fixing the bumper on their car and the answer is clear. It's usually then that the obligatory policy wonks, who whisper in the ear of the congresspeople to cut payments to doctors, become glassy eyed and change the subject. 

Doctors want to take care of patients and be paid commensurate with their training, expertise and efforts. Until folks on the Hill hear the public outcry from the coming shock of doctors leaving the profession and/or leaving Medicare, nothing will change and they will continue to wonder why they aren't saving any money.  

Morgan Lorio, MD. Advanced Orthopedics (Altamonte Springs, Fla.): Congress should face the same medical insurance we face. The unstable and unsustainable inequity manufactured by the 2023 CMS final rule is an extinction event for Medicare seniors by design. To say this is the wrong way forward is a euphemism for what will be a drastic reduction in access impacting spine patients. This crippling, egregious act by CMS is the equivalent of a surgeon amputating the wrong leg, leaving no real way forward. Unless Congress provides an immediate remedy, spine surgeons will resign in a Biblical exodus.

A referendum forcing Congress to face the same harsh reality in insurance coverage that Medicare patients suffer should provide a long-term, reasonable solution.

Issada Thongtrangan, MD. Microspine (Scottsdale, Ariz.): This is sad but not surprising as it has always been a "cut" on a fee for service for the physician. It came at a time when the economic situation is at the highest inflation rate.

As an independent physician, I am running pretty lean to cut the cost and still maintain the quality of care to the patients, especially Medicare folks who are usually older and unhealthy. I may have to rethink the strategies that I still offer the quality of care with this pay cut. One of the strategies I heard from many practices is to limit seeing Medicare patients. At the end of the day, the ones who suffered the most were the Medicare patients. I hope the CMS realized the situation and does not keep cutting the payment every year. 

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