From physician work value to federal policy reform, here is how three spine and orthopedic organizations approach advocacy in 2025 and beyond:
North American Spine Society: NASS President William Mitchell, MD, said a local focus on advocacy is just as important as work on the federal stage.
“NASS advocates on both levels,” he said. “Our federal advocacy is in collaboration with other like minded stakeholders, e.g. professional medical organizations. The focus is going to continue, from my perspective, on giving our members the guidelines and coverage policy reviews and letters and documentation that supports quality spine care. A lot of what we do is come up with coverage policies on what should be done, and then members can use that to advocate locally. Some payers use these products as work to develop their own policies, so that’s one avenue. We have been doing that for a long time. But I hope to put more focus on tools physicians can use to help make their case for treatment for their patients.”
International Society for the Advancement of Spine Surgery: Fair valuation is a top advocacy priority for Morgan Lorio, MD, past president of the International Society for the Advancement of Spine Surgery and chair emeritus of ISASS’ coding and reimbursement task force. He cited Medicare’s Physician Fee Schedule which includes a 2.5% “efficiency adjustment” to the work RVUs of non-time-based procedures.
“This policy shift breaks from the longstanding RUC formula of work = time × intensity, substituting actuarial assumption for clinical reality,” Dr. Lorio said. “For spine surgeons, whose operative times are growing longer and more complex due to aging patients and minimally invasive innovations, this so-called “efficiency gain” is neither observed nor evidence-based. It represents a silent erosion of value, devaluing skilled work without regard for patient acuity, intraoperative decision-making or postoperative burden.”
Dr. Lorio said he’s focused on three interlinked goals: Preserving the RUC formula of work, push for specialty-specific representation and reform Medicare Advantage prior authorization.
“The cost of inaction is high,” Dr. Lorio said. “As the real value of surgical work is chipped away through RVU deflation, inflation ignorance, and administrative overreach, we risk driving the next generation of surgeons away from procedural specialties. We must advocate not just for dollars, but for the dignity of surgical labor and the patients it serves.”
American Academy of Orthopaedic Surgeons: AAOS President Annunziato “Ned” Amendola, MD, said he’s monitoring a constantly changing environment in healthcare policy.
“Changes are happening so quickly, and things are volatile in every way,” he said. “At my institution where I work, they’ve really been hit hard with the proposed changes in healthcare funding, the proposed changes in research, the concern about diversity, equity and inclusion and what academic institutions are doing. There’s a lot of things on the plate, and we’re trying to really look at all these changes and what we’re doing in terms of delivering care. We’re still going to have a strong voice on Capitol Hill with our Office of Government Relations and the AAOS Advocacy Council, and we’re going to continue to communicate with all the representatives, all the state societies and collaborate with other organizations to advocate for physicians and patient care.”
Dr. Amendola said the AAOS has also been focused on empowering patients in advocacy through education and engagement.
