Amid changes in federal healthcare policy, data tools will become increasingly important for spine surgeons, Andrew Fanous, MD, said.
Dr. Fanous, of Alexandria, Va.-based Inova, joined the “Becker’s Spine and Orthopedic Podcast” to discuss what spine surgeons can do to stay ahead.
Note: This is an edited excerpt. Listen to the full conversation here.
Question: There have been several developments in federal healthcare policy, from the GOP spending bill to CMS’ proposed 2026 physician fee schedule. How are you thinking about these changes and how it affects the growth of spine technologies?
Dr. Andrew Fanous: With the One Big Beautiful Bill, there will be tighter Medicaid budgets and stricter eligibility for surgeries. It will slash Medicaid provider taxes, it will tighten eligibility, and it’s going to add work requirements. This could reduce volume of spine surgery referrals from Medicaid, especially when it comes to rural areas and low income areas. In addition, rural and community hospitals may face operational strains, even though there will be increased funding for rural hospitals. This may not offset the overall cuts, and as a result, spine tech vendors may see kind of lower uptake in these areas of rural areas and community hospital areas, and they may need to shift their focus to better-funded hospital systems and even to private payer markets.
When it comes to the CMS and the proposed 2026 physician fee schedule, it’s also a mixed bag because there will be higher base conversion factors. CMS is proposing about a 3.7% boost to physician payments for 2026. However, when it comes to procedure-based specialties like spine surgery, there will be about a 2.5% cut. They’re calling it the efficiency cut, and that adjustment is probably going to end up offsetting the proposed boost in physician payments. Mandatory ambulatory specialty models or ASMs are a new model, and are mainly targeting spine and heart failure management, and it rewards usage of digital tools, care coordination and outcome tracking. As a result, despite surgeons, their effective reimbursement may stagnate or may even decline, and that’s going to make investments in high-cost technologies less financially appealing.
On the other hand, there will be new opportunities created by the ambulatory specialty model, through remote monitoring, telehealth, patient engagement platforms and so on. The takeaways for the spine sector is that there will be a shift to value-driven propositions. Surgeons will need to engage early into alternative payment models, and there will be a focus on data, data and sort of evidence based medicine. CMS will increasingly reward data-driven outcome tracking, and the market winners will be the ones who are offering measurable value.
Q: How could artificial intelligence and augmented reality tools help surgeons gather that data needed to show their value?
AF: AI-enhanced surgical assistance is going to play a larger role in predicting the most effective surgical approaches and the tools for each patient. And when you employ AI to analyze thousands of databases from previous surgeries, AI can recommend optimal approaches for achieving the best possible outcome, and it can also perform predictive analytics down the road. You can use software to predict complications, healing times and patient-specific risks based on the unique anatomy and pathology and history of the patient. That would ensure that the surgeons are more informed before making decisions, and that will result in more individualized treatment plans. This would further reduce complications and improve surgical precision down the road, which is really what CMS is looking for.
