Spine surgeons uneasy amid CMS's pay drop


Spine surgeons are unhappy with CMS after plans for 2024 physician pay were revealed last week.

On Nov., 2, CMS released the 2024 Physician Fee Schedule and Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rules, cutting physician pay 1.25% and lowering the conversion factor 3.4%. The agency opted to cut physician pay despite the Medicare Economic Index increases, which measures medical practice cost inflation. The MEI jumped 4.6% in the last year.

The pay decision has been met with criticism from physician organizations, and spine surgeons see it especially burdensome for independent physicians.

"I believe this will accelerate current trends," said Harel Deutsch, MD, co-director of the Rush Spine Center in Chicago. "Physicians in private practice will not be able to sustain a practice treating Medicare patients. There will be decreased access to care for Medicare patients and generally more treatment through nurse practitioners and physician assistants."

The North American Spine Society is still reviewing the final rule to determine how it will affect spine specialists, according to John Finkenberg, MD, a spine surgeon with Alvarado Specialists of San Diego and member of the NASS board of directors.

Members of the House of Representatives came together earlier this year to develop a bipartisan bill to tie physician pay updates to the MEI, based on recommendations from MedPAC, but no changes have been made.

"We are supporting HR 2474 as it provides annual updates to increases in the MEI," said Dr. Finkenberg. "Also, CMS claims that there is no mechanism to identify expenses for facility based on physicians so approximately 200,000 physicians are not being included in determining the balance between physician work payment and cost of professional liability insurance. Finally, the process of bundling work performed into codes that reimburse physicians significantly less doesn't take into account the physicians' obligation to still add work time and effort into the complex spine procedures."

There is also a Senate Finance Committee proposal to mitigate some of the cuts, but it would still lead to pay reductions as physician practices are seeing increased costs due to inflation.

"Congress must either delay the G code implementation, or preferably, provide funding for the G code," said Adam Bruggeman, MD, CEO of Texas Spine Center in San Antonio. "For the long term, we need to tie physician pay to the actual cost of doing business. There are several ideas on how to accomplish this, including the Doc Caucus's proposal from last month."

CMS did increase pay for primary care and mental healthcare with the goal of increasing access to care and health equity. But the lower pay for specialists could have the opposite effect.

"Much ink has been spilled on how CMS cannot in good conscience state that these rules 'expand access' and 'advance equity' when they continue to cut pay to physicians despite advice to the contrary from MedPAC and hundreds of healthcare organizations," said Dr. Bruggeman. "The implemented policies will only further encourage physicians to drop out of Medicare, and by definition Medicare Advantage, which reduces access to over 65 million Americans."

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